Provider Demographics
NPI:1124313408
Name:ALLEN, GLORIA (PASTOR)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2454
Mailing Address - Country:US
Mailing Address - Phone:504-239-4171
Mailing Address - Fax:504-328-1611
Practice Address - Street 1:1448 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2454
Practice Address - Country:US
Practice Address - Phone:504-239-4171
Practice Address - Fax:504-328-1611
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral