Healthcare Provider Details

I. General information

NPI: 1992467096
Provider Name (Legal Business Name): CHERITA KAYE TOLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N HACKBERRY ST
SWEENY TX
77480-3114
US

IV. Provider business mailing address

102 N HACKBERRY ST
SWEENY TX
77480-3114
US

V. Phone/Fax

Practice location:
  • Phone: 832-229-2571
  • Fax:
Mailing address:
  • Phone: 832-229-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number16597
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: