Provider Demographics
NPI:1053789958
Name:ALLEN, ELISA N (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:N
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1211
Mailing Address - Country:US
Mailing Address - Phone:615-597-4673
Mailing Address - Fax:615-597-4673
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1211
Practice Address - Country:US
Practice Address - Phone:615-597-4673
Practice Address - Fax:615-597-4673
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3737101YP2500X, 101YA0400X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist