Provider Demographics
NPI:1912758624
Name:ALLEN, TENISHA (MENTAL HEALTH WORKER)
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MENTAL HEALTH WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 GOTZIAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4635
Mailing Address - Country:US
Mailing Address - Phone:616-548-7399
Mailing Address - Fax:
Practice Address - Street 1:7362 UNIVERSITY AVE NE STE 310-5
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3142
Practice Address - Country:US
Practice Address - Phone:616-548-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1465738100021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health