Basic Information
| Provider Information | |||||||||
| NPI: | 1891129185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | KLETA | ||||||||
| MiddleName: | A | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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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 | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | LPC-1533 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.