Miko Rae Allen, PT, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

117683 Issued in CA

Practice address

175 Fairview LN
Sonora, CA 95370-4809

Phone

(805) 591-9990

NPI assigned

Nov 3, 2020

Last updated

Mar 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Woods Creek Psychological Group, Apc

  • Psychologist
  • Sonora, CA
  • NPI 1861851503
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1386245694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22572 LITTLE JOHN DR",
            "city": "TWAIN HARTE",
            "state": "CA",
            "postal_code": "953839758",
            "telephone_number": "805-591-9990",
            "fax_number": "209-336-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 FAIRVIEW LN",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704809",
            "telephone_number": "805-591-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "MIKO",
        "middle_name": "RAE",
        "credential": "PT, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-03",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "117683",
            "primary": true
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "37930",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Sonora",
            "affiliation": "N",
            "address_1": "175 Fairview Ln",
            "city": "Sonora",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953704809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teresa Lynn Alford, PPS
• Benjamin M Alger, PHARM.D.
• Jessica Alkema, DPT
• Mary Gail Allard, PHARMD
• David Eugene Allen, M.D.
• Karissa Alley
• Arturo Alvarez Antezana, MD
• Carlos Alvarez, M.D.
• Amador Community Action Agency
• Amador-Tuolumne Community Action Agency

• Clinical Social Worker in Sonora, CA
• Providers in Sonora, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.