Provider Demographics
NPI:1487219788
Name:RAMIREZ, ALLEN JAY (MS, AMFT)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:JAY
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:JIMENA
Other - Middle Name:JAY
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, AMFT
Mailing Address - Street 1:51 ZACA LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7353
Mailing Address - Country:US
Mailing Address - Phone:805-781-6400
Mailing Address - Fax:
Practice Address - Street 1:51 ZACA LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7353
Practice Address - Country:US
Practice Address - Phone:805-781-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
CA119045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program