Basic Information
| Provider Information | |||||||||
| NPI: | 1851669519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | ASHLEIGH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A. CM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 N GRAND AVE STE 319 | ||||||||
| Address2: | |||||||||
| City: | OKMULGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744474031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187581930 | ||||||||
| FaxNumber: | 9187581920 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 N GRAND AVE STE 319 | ||||||||
| Address2: | |||||||||
| City: | OKMULGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744474031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187581930 | ||||||||
| FaxNumber: | 9187581920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2011 | ||||||||
| LastUpdateDate: | 12/09/2011 | ||||||||
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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 | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.