Provider Demographics
NPI:1942571401
Name:ALLEN, CRYSTAL BROOKE (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:BROOKE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:BROOKE
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5111
Practice Address - Street 1:1300 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4264
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5111
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010042089103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst