Healthcare Provider Details

I. General information

NPI: 1427595966
Provider Name (Legal Business Name): NICOLE TOBEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 LEMMON AVE SUITE 200
DALLAS TX
75219-2145
US

IV. Provider business mailing address

4525 LEMMON AVE SUITE 200
DALLAS TX
75219-2145
US

V. Phone/Fax

Practice location:
  • Phone: 214-526-4525
  • Fax: 214-520-6468
Mailing address:
  • Phone: 214-526-4525
  • Fax: 214-520-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: