Provider Demographics
NPI:1376789115
Name:TOBERT, MELODY L
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:TOBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:L
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4033
Mailing Address - Country:US
Mailing Address - Phone:870-659-5455
Mailing Address - Fax:
Practice Address - Street 1:124 S JACKSON STE 308
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3540
Practice Address - Country:US
Practice Address - Phone:870-234-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health