Healthcare Provider Details

I. General information

NPI: 1467697805
Provider Name (Legal Business Name): VIVIAN ELAINE TOLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 HICKORY
BROOKELAND TX
75931
US

IV. Provider business mailing address

PO BOX 5208
JASPER TX
75951-7702
US

V. Phone/Fax

Practice location:
  • Phone: 409-698-2382
  • Fax:
Mailing address:
  • Phone: 409-698-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: