Provider Demographics
NPI:1972325553
Name:ALLEN, AINSLEY
Entity type:Individual
Prefix:
First Name:AINSLEY
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:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-1823
Mailing Address - Country:US
Mailing Address - Phone:318-588-8908
Mailing Address - Fax:318-588-8909
Practice Address - Street 1:628 COMMERCIAL PKWY STE 2
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-8062
Practice Address - Country:US
Practice Address - Phone:318-245-4113
Practice Address - Fax:318-588-8909
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR-16230106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-24-320719OtherBACB