Provider Demographics
NPI:1952585192
Name:ALLEN, JAMES L (MA LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:L
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 WILD ROSE LN
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-9038
Mailing Address - Country:US
Mailing Address - Phone:509-675-4095
Mailing Address - Fax:
Practice Address - Street 1:1101 WILD ROSE LN
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-9038
Practice Address - Country:US
Practice Address - Phone:509-675-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00005560Medicaid