Provider Demographics
NPI:1235022187
Name:ALLEN, MADILYN GRACE
Entity type:Individual
Prefix:
First Name:MADILYN
Middle Name:GRACE
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 1:5382 E 81ST ST APT 933
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2258
Mailing Address - Country:US
Mailing Address - Phone:405-615-1444
Mailing Address - Fax:
Practice Address - Street 1:3705 W MEMORIAL RD STE 702
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1507
Practice Address - Country:US
Practice Address - Phone:405-615-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-25-439904106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician