MEDICARE: MS. PHYLLIS TONKIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	30913	TX

General Provider Information

NPI Number	:	1497738405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHYLLIS TONKIN LCSW

Provider Business Mailing Address
First Line	:	7500 SAN FELIPE ST
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77063-1707
Country	:	US
Telephone Number	:	713-668-6666
Fax Number	:	713-668-6663

Provider Business Practice Location Address
First Line	:	7500 SAN FELIPE ST
Second Line	:	SUITE 600
City	:	HOUSTON
State	:	TX
Zip	:	77063-1707
Country	:	US
Telephone Number	:	713-668-6666
Fax Number	:	713-668-6663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	06/28/2016

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