Healthcare Provider Details

I. General information

NPI: 1588316657
Provider Name (Legal Business Name): MS. TOLLIVER FAVORITE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 AVONDALE GARDEN RD
WESTWEGO LA
70094-2608
US

IV. Provider business mailing address

344 AVONDALE GARDEN RD
WESTWEGO LA
70094-2608
US

V. Phone/Fax

Practice location:
  • Phone: 832-492-2256
  • Fax:
Mailing address:
  • Phone: 832-492-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC9298
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9298
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: