Provider Demographics
NPI:1932786811
Name:ALLEN, DARRIELLE
Entity type:Individual
Prefix:
First Name:DARRIELLE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 MAYFIELD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2215
Mailing Address - Country:US
Mailing Address - Phone:440-312-7470
Mailing Address - Fax:440-312-7488
Practice Address - Street 1:6803 MAYFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2215
Practice Address - Country:US
Practice Address - Phone:440-312-7470
Practice Address - Fax:440-312-7488
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000492103T00000X
OHP.08695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist