Provider Demographics
NPI:1689028458
Name:ALLEN'S THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:ALLEN'S THERAPEUTIC SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:MARCELLUS
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-446-5676
Mailing Address - Street 1:5455 W 86TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1504
Mailing Address - Country:US
Mailing Address - Phone:317-820-3600
Mailing Address - Fax:317-663-0914
Practice Address - Street 1:5455 W 86TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1504
Practice Address - Country:US
Practice Address - Phone:317-820-3600
Practice Address - Fax:317-663-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003862A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty