Provider Demographics
NPI:1457326621
Name:ALLEN, MOLLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N WACO AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3953
Mailing Address - Country:US
Mailing Address - Phone:316-260-4587
Mailing Address - Fax:316-260-4676
Practice Address - Street 1:727 N WACO AVE STE 255
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3953
Practice Address - Country:US
Practice Address - Phone:316-260-4587
Practice Address - Fax:316-260-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS855103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100241200BMedicaid
KS119712Medicare ID - Type Unspecified