Healthcare Provider Details

I. General information

NPI: 1487170429
Provider Name (Legal Business Name): MARY TOBIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 DELTA HORIZON DR
SLIDELL LA
70461-6128
US

IV. Provider business mailing address

901 OLD SPANISH TRL APT 12
SLIDELL LA
70458-5010
US

V. Phone/Fax

Practice location:
  • Phone: 337-378-8073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7781
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1370
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: