Provider Demographics
NPI:1457119273
Name:ALLEN, LONDON
Entity Type:Individual
Prefix:
First Name:LONDON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 MYSTIC FOREST LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-6102
Mailing Address - Country:US
Mailing Address - Phone:170-493-0430
Mailing Address - Fax:
Practice Address - Street 1:4819 MYSTIC FOREST LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-6102
Practice Address - Country:US
Practice Address - Phone:170-493-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician