Basic Information
| Provider Information | |||||||||
| NPI: | 1093746273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AOD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930034113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057656495 | ||||||||
| FaxNumber: | 8057656490 | ||||||||
| Practice Location | |||||||||
| Address1: | 5225 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930034113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057656495 | ||||||||
| FaxNumber: | 8057656490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY15636 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 1598786352 | 05 | CA | MEDICAID | 1356344758 | 05 | CA | MEDICAID | 1528072386 | 05 | CA | MEDICAID | 237310613 | 01 | CA | BX/BS | OTHER |