Healthcare Provider Details

I. General information

NPI: 1578222774
Provider Name (Legal Business Name): ALLYSON HAWKINS, PH.D. PROFESSIONAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 E WASHINGTON ST STE A7
BLOOMINGTON IL
61704-1612
US

IV. Provider business mailing address

2416 E WASHINGTON ST STE A7
BLOOMINGTON IL
61704-1612
US

V. Phone/Fax

Practice location:
  • Phone: 309-532-0481
  • Fax:
Mailing address:
  • Phone: 309-532-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLYSON HAWKINS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 309-532-0481