Provider Demographics
NPI:1679218101
Name:ALLEN, ANNIE (LMSW)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3821
Mailing Address - Country:US
Mailing Address - Phone:936-635-8901
Mailing Address - Fax:
Practice Address - Street 1:462 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3821
Practice Address - Country:US
Practice Address - Phone:936-635-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050411041C0700X, 104100000X
ID444251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical