Basic Information
| Provider Information | |||||||||
| NPI: | 1700855129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MSW, LISW, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5750 CAMBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | NEW CONCORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437629680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408264871 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E669 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | I1464 | OH | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 000000176697 | 01 | OH | ANTHEM PIN | OTHER | 112402 | 01 | OH | MOUNT CARMEL PIN | OTHER | 1044430 | 01 | OH | CIGNA BH PIN | OTHER | 212123 | 01 | OH | TRICARE/MHN PIN | OTHER | 6207781 | 01 | OH | UBH PIN | OTHER | 7399187 | 01 | OH | AETNA PIN | OTHER | Y147362 | 01 | OH | THE HEALTH PLAN PIN | OTHER | 112401 | 01 | OH | MOUNT CARMEL PIN | OTHER | 142096 | 01 | OH | COMPSYCH BH PIN | OTHER |