Provider Demographics
NPI:1740689033
Name:ALLEN, ADAM (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12219 DUNBAR CIR N
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3211
Mailing Address - Country:US
Mailing Address - Phone:918-575-3166
Mailing Address - Fax:
Practice Address - Street 1:1700 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1316
Practice Address - Country:US
Practice Address - Phone:317-554-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002961A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health