Provider Demographics
NPI:1588071427
Name:ALLEN, CHRISTOPHER DANIEL
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WALLACE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2948
Mailing Address - Country:US
Mailing Address - Phone:801-885-0559
Mailing Address - Fax:
Practice Address - Street 1:110 E WALLACE AVE STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2948
Practice Address - Country:US
Practice Address - Phone:801-885-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10508102-3902101YM0800X
IDLMFT-9960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health