Basic Information
| Provider Information | |||||||||
| NPI: | 1578881124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DEVON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LPC, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 NE 8TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731172202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054361506 | ||||||||
| FaxNumber: | 4059484933 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 WESTPARK DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730694012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055794111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2010 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1150 | OK | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 5228 | OK | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC1900X | 1329 | OK | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 200485210 | 05 | OK | MEDICAID |