Provider Demographics
NPI:1720684152
Name:ALLEN, MICHAEL JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2480
Mailing Address - Country:US
Mailing Address - Phone:510-254-5157
Mailing Address - Fax:510-338-4889
Practice Address - Street 1:7200 BANCROFT AVE STE 133
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2480
Practice Address - Country:US
Practice Address - Phone:510-254-5157
Practice Address - Fax:510-338-4889
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2021-01-27
Deactivation Date:2021-01-05
Deactivation Code:
Reactivation Date:2021-01-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health