Provider Demographics
NPI:1639564032
Name:MCCONNELL, ALLEN DALE JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DALE
Last Name:MCCONNELL
Suffix:JR
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:2 EASTON OVAL STE 450
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6035
Mailing Address - Country:US
Mailing Address - Phone:614-475-9500
Mailing Address - Fax:614-475-9821
Practice Address - Street 1:140 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3602
Practice Address - Country:US
Practice Address - Phone:269-966-1460
Practice Address - Fax:269-979-7766
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI6301015977103TC0700X
OH7561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301015977OtherLICENSE #
OH7561OtherLICENSE # 7561