Provider Demographics
NPI:1285649038
Name:OUTLAND, TONETTE BONITA (N/A)
Entity Type:Individual
Prefix:
First Name:TONETTE
Middle Name:BONITA
Last Name:OUTLAND
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S. LOOP WEST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5613
Mailing Address - Country:US
Mailing Address - Phone:713-669-1090
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:2626 S. LOOP WEST
Practice Address - Street 2:SUITE 625
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5613
Practice Address - Country:US
Practice Address - Phone:713-271-8051
Practice Address - Fax:713-271-8069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)