Allen, Wilson Elijah

Allen, Wilson Elijah is an individual health care provider with primary practice located at 1025 N Country Club Dr , Mesa AZ 85201-3307. He recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as his primary health care specialty. Allen, Wilson Elijah can be contacted via phone (480) 472-1813.

Contact Information

Primary practice address
1025 N Country Club Dr Mesa AZ 85201-3307
Phone: (480) 472-1813
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X

Profile Details

NPI number 1295854677
LBN Legal business name Allen, Wilson Elijah
Credentials ED.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 28th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295854677 NPPES
Arizona MEDICAID 588395

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