Provider Demographics
NPI:1871064980
Name:ALLEN, DESIRAE LOUISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DESIRAE
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 SHADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELSMERE
Mailing Address - State:KY
Mailing Address - Zip Code:41018-4050
Mailing Address - Country:US
Mailing Address - Phone:620-664-7393
Mailing Address - Fax:
Practice Address - Street 1:126 WELLINGTON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1710
Practice Address - Country:US
Practice Address - Phone:620-664-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical