Provider Demographics
NPI:1245859982
Name:ALLEN, THOMAS (LP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VALLEY VIEW PL
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-2500
Mailing Address - Country:US
Mailing Address - Phone:612-581-4523
Mailing Address - Fax:
Practice Address - Street 1:12 VALLEY VIEW PL
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2500
Practice Address - Country:US
Practice Address - Phone:612-581-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6500103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling