Provider Demographics
NPI:1710666276
Name:ALLEN, NICCO (ACMHC)
Entity type:Individual
Prefix:
First Name:NICCO
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 S PRICE RD STE 209A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6609
Mailing Address - Country:US
Mailing Address - Phone:801-410-0171
Mailing Address - Fax:
Practice Address - Street 1:1490 S PRICE RD STE 209A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6609
Practice Address - Country:US
Practice Address - Phone:801-410-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5499201-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health