Provider Demographics
NPI:1871204818
Name:ALLEN, AMY J (LCPC, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ROYAL SAINT GEORGES CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-8736
Mailing Address - Country:US
Mailing Address - Phone:847-727-0034
Mailing Address - Fax:
Practice Address - Street 1:2505 ROYAL SAINT GEORGES CT
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-8736
Practice Address - Country:US
Practice Address - Phone:847-727-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional