Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 528 | ND |
NPI | 1003300187 |
---|---|
Provider Name | Dr. Jaryn Lynn Allen |
First Address | Fargo, ND 58104-8647 |
Second Address | Fargo, ND 58104-8647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |