Basic Information
Provider Information | |||||||||
NPI: | 1740426105 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALLEN | ||||||||
FirstName: | DONALD | ||||||||
MiddleName: | FRANCIS | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALLEN | ||||||||
OtherFirstName: | DON | ||||||||
OtherMiddleName: | F. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1430 WILKINS CIRCLE | ||||||||
Address2: |   | ||||||||
City: | CASPER | ||||||||
State: | WY | ||||||||
PostalCode: | 82601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3072379583 | ||||||||
FaxNumber: | 3072657277 | ||||||||
Practice Location | |||||||||
Address1: | 1430 WILKINS CIRCLE | ||||||||
Address2: |   | ||||||||
City: | CASPER | ||||||||
State: | WY | ||||||||
PostalCode: | 82601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3072379583 | ||||||||
FaxNumber: | 3072657277 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/06/2009 | ||||||||
LastUpdateDate: | 01/06/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LPC#492 | WY | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
No ID Information.