Provider Demographics
NPI:1174607022
Name:DOUGLAS B. ALLEN, PH.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:DOUGLAS B. ALLEN, PH.D., A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-773-2100
Mailing Address - Street 1:23241 VENTURA BLVD
Mailing Address - Street 2:STE. 209
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1003
Mailing Address - Country:US
Mailing Address - Phone:818-773-2100
Mailing Address - Fax:818-704-7016
Practice Address - Street 1:23241 VENTURA BLVD
Practice Address - Street 2:STE. 209
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1003
Practice Address - Country:US
Practice Address - Phone:818-773-2100
Practice Address - Fax:818-704-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10028103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty