Provider Demographics
NPI:1689418410
Name:ALLEN, RAYMOND PAUL JR (SUDPT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:PAUL
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:615 EAST FAIVIEW
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207
Mailing Address - Country:US
Mailing Address - Phone:509-714-4686
Mailing Address - Fax:
Practice Address - Street 1:1321 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2803
Practice Address - Country:US
Practice Address - Phone:509-327-3120
Practice Address - Fax:509-327-3228
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61227940101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)