Provider Demographics
NPI:1932570942
Name:ALLEN, WILLIE EUGENE (MA,)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:EUGENE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA,
Other - Prefix:
Other - First Name:WILLIE
Other - Middle Name:EUGENE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,
Mailing Address - Street 1:1632 THOMAS H DELPIT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-6628
Mailing Address - Country:US
Mailing Address - Phone:225-572-1870
Mailing Address - Fax:225-778-0992
Practice Address - Street 1:8706 JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2233
Practice Address - Country:US
Practice Address - Phone:225-926-9706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9419101YM0800X, 171M00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932570942Medicaid