Healthcare Provider Details

I. General information

NPI: 1457326621
Provider Name (Legal Business Name): MOLLY ALLEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N WACO AVE STE 255
WICHITA KS
67203-3953
US

IV. Provider business mailing address

727 N WACO AVE STE 255
WICHITA KS
67203-3953
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-4587
  • Fax: 316-260-4676
Mailing address:
  • Phone: 316-260-4587
  • Fax: 316-260-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number855
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number855
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: