Nicole C Allen
Individual provider Active NPI Health Service Psychologist · Avon, IN
NPI 1962993063 · NPPES record last updated May 24, 2018
Key facts
- NPI
- 1962993063
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Health Service Psychologist 103TH0100X
- License
- CNA1001520 (IN)
- Practice address
- 595 W Edge TRL Apt O
Avon, IN 46123-6841 - Phone
- (317) 981-0069
- NPI assigned
- May 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNA1001520 | IN | MD | Health Service Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicole'S Journey Is Caring LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | CNA1001520 | IN | Yes |
Addresses
Primary practice location
595 W Edge TRL Apt O
Avon, IN 46123-6841
Mailing address
595 W Edge TRL Apt O
Avon, IN 46123-6841
Phone (317) 981-0069
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All providers in Avon, IN · Health Service Psychologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.