Provider Demographics
NPI:1174680805
Name:ALLEN, DIAN R (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DIAN
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4431
Mailing Address - Country:US
Mailing Address - Phone:707-331-8551
Mailing Address - Fax:
Practice Address - Street 1:526 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4431
Practice Address - Country:US
Practice Address - Phone:707-331-8551
Practice Address - Fax:707-980-6576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1300101YP2500X
CA32508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA286OtherMEDI-CAL STAFF BILLING #