Provider Demographics
NPI:1245519792
Name:TOLLEFSON, DREW J (BA, MHP)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:J
Last Name:TOLLEFSON
Suffix:
Gender:M
Credentials:BA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 E KERR AVE
Mailing Address - Street 2:108
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9119
Mailing Address - Country:US
Mailing Address - Phone:502-475-7752
Mailing Address - Fax:
Practice Address - Street 1:502 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3634
Practice Address - Country:US
Practice Address - Phone:217-373-2430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health