Provider Demographics
NPI:1164200150
Name:TOBER, HALEIGH
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:
Last Name:TOBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 N FITZHUGH AVE APT 1330
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3143
Mailing Address - Country:US
Mailing Address - Phone:817-583-1820
Mailing Address - Fax:
Practice Address - Street 1:1926 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-7954
Practice Address - Country:US
Practice Address - Phone:469-925-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-144900106S00000X
TX6557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician