1497970404 NPI number — MR. ALLEN KENT MACEACHERN LMFT

Table of content: MR. ALLEN KENT MACEACHERN LMFT (NPI 1497970404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497970404 NPI number — MR. ALLEN KENT MACEACHERN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACEACHERN
Provider First Name:
ALLEN
Provider Middle Name:
KENT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACEACHERN
Provider Other First Name:
KENT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497970404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 CLIFFWOOD DR # A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-849-0453
Provider Business Mailing Address Fax Number:
843-849-6219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 CLIFFWOOD DR # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-849-0453
Provider Business Practice Location Address Fax Number:
843-849-6219
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1136 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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