Provider Demographics
NPI:1144736661
Name:TOLIBAS, SUSAN F (RBT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:TOLIBAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 PALOMA HTS APT 107
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3258
Mailing Address - Country:US
Mailing Address - Phone:719-291-0100
Mailing Address - Fax:
Practice Address - Street 1:14182 PETREL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2464
Practice Address - Country:US
Practice Address - Phone:719-310-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15-00503106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician