Healthcare Provider Details

I. General information

NPI: 1225961691
Provider Name (Legal Business Name): ALLISON CHRISTINE WILLIAMS TOLLEFSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N MAIN ST
EL DORADO KS
67042-2024
US

IV. Provider business mailing address

430 N WALNUT ST
AUGUSTA KS
67010-1036
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-6036
  • Fax:
Mailing address:
  • Phone: 316-775-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03517
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: