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General NPI Number Information
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NPI Number | 1811629033
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Entity Type | Organization
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Legal Business Name | KOLLETTE TOLBERT, LLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 17350 STATE HIGHWAY 249 STE 220-6454
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City | HOUSTON
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State | TX
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Zip | 77064-1147
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Country | US
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Telephone | 361-238-7355
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Fax | 361-214-2861
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | GANADO
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State | TX
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Zip | 77962-0417
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Country | US
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Telephone | 361-437-0462
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Fax | 361-214-2861
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Authorized Official
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Title or Position | LPC/CEO
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Name | KOLLETTE D TOLBERT
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Credential | LPC
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Telephone | 361-437-0462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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