Provider Demographics
NPI:1740373828
Name:ALLEN, ANDREW C (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5120E FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8525
Mailing Address - Country:US
Mailing Address - Phone:918-213-4977
Mailing Address - Fax:918-214-8051
Practice Address - Street 1:226 SE DEBELL AVE
Practice Address - Street 2:BLDG. A
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2343
Practice Address - Country:US
Practice Address - Phone:918-331-1090
Practice Address - Fax:918-331-1091
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200278840AMedicaid
OK200278840AMedicaid