Individual
MARYA ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMLP, LMAC, LBP
Contact information
Practice address
1313 W FERGUSON AVE, BLACKWELL, OK 74631-5604
(580) 363-4400
Mailing address
1313 W FERGUSON AVE, BLACKWELL, OK 74631-5604
(580) 363-4400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1237
KS
101YM0800X
Mental Health Counselor
Primary
10397
OK
103TC0700X
Clinical Psychologist
728
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12989
PREFERRED HEALTH SYSTEMS
KS
01
—
389893
BLUE CROSS BLUE SHIELD
KS
Enumeration date
06/12/2006
Last updated
12/29/2021
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