Provider Demographics
NPI:1306902655
Name:ALLEN, C. CHRISTOPHER (PHD, PSC)
Entity type:Individual
Prefix:
First Name:C.
Middle Name:CHRISTOPHER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD, PSC
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:CHRISTOPHER
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:111 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2916
Mailing Address - Country:US
Mailing Address - Phone:859-276-5243
Mailing Address - Fax:859-260-1538
Practice Address - Street 1:111 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2916
Practice Address - Country:US
Practice Address - Phone:859-276-5243
Practice Address - Fax:859-260-1538
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 0820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0967701Medicare UPIN