Provider Demographics
NPI:1316116924
Name:ALLEN, JEFFREY
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR JEFFREY C ALLEN
Mailing Address - Street 1:700 E MELTON ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1808
Mailing Address - Country:US
Mailing Address - Phone:903-241-5208
Mailing Address - Fax:
Practice Address - Street 1:700 E MELTON ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1808
Practice Address - Country:US
Practice Address - Phone:903-241-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72269101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316116924Medicaid
TX171M00000XMedicaid