Provider Demographics
NPI:1801456702
Name:ALLEN WELLNESS CENTER
Entity type:Organization
Organization Name:ALLEN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-213-2182
Mailing Address - Street 1:6922 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7600
Mailing Address - Country:US
Mailing Address - Phone:253-213-2182
Mailing Address - Fax:253-369-9651
Practice Address - Street 1:6922 22ND ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-7600
Practice Address - Country:US
Practice Address - Phone:253-213-2182
Practice Address - Fax:253-369-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health