Provider Demographics
NPI:1366184319
Name:ALLEN, TODD (PMHNP)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3111
Mailing Address - Country:US
Mailing Address - Phone:801-857-1314
Mailing Address - Fax:
Practice Address - Street 1:3311 N UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7421
Practice Address - Country:US
Practice Address - Phone:385-504-1334
Practice Address - Fax:801-210-5812
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT54603994408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health