Healthcare Provider Details

I. General information

NPI: 1548077381
Provider Name (Legal Business Name): MRS. TOI CHRISTINE DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 RIO GRANDE LN
ROSHARON TX
77583-4050
US

IV. Provider business mailing address

12607 RIO GRANDE LN
ROSHARON TX
77583-4050
US

V. Phone/Fax

Practice location:
  • Phone: 708-227-7981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: