Provider Demographics
NPI:1437415965
Name:J SCOTT ALLEN JR PHD LLC
Entity type:Organization
Organization Name:J SCOTT ALLEN JR PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-626-7008
Mailing Address - Street 1:26111 W 14 MILE RD # 201C
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1168
Mailing Address - Country:US
Mailing Address - Phone:248-626-7008
Mailing Address - Fax:248-626-7057
Practice Address - Street 1:26111 W 14 MILE RD # 201C
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1168
Practice Address - Country:US
Practice Address - Phone:248-626-7008
Practice Address - Fax:248-626-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJA007894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3237Medicare PIN
MIR66196Medicare UPIN
MI0M54850Medicare PIN