Provider Demographics
NPI:1659640175
Name:ALLEN, JESSICA RUTH (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RUTH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 DAYLILY DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4924
Mailing Address - Country:US
Mailing Address - Phone:727-947-0778
Mailing Address - Fax:719-325-8978
Practice Address - Street 1:1751 DAYLILY DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4924
Practice Address - Country:US
Practice Address - Phone:727-947-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13185101YM0800X
FL4860106H00000X
NV4673-R106H00000X
COMFT.0001348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health