| Doctor Name: | MR. JOHN WILLIAM TOLLETTE |
| NPI Number: | 1417312182 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 1803 |
| Business Practice Address: | 1405 E Moses Cushing, OK - 74023 |
| Business Phone Number: | 9182255600 |
| Business Fax Number: | |
| Mailing Address: | 1405 E Moses, CUSHING |
| State: | OK |
| Postal Code: | 74023 |
| Phone Number: | 9182255600 |
| Fax Number: | 9182253026 |
| NPI Enumeration Date: | 12/23/2015 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | 1803 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |