Provider Demographics
NPI:1497738405
Name:TONKIN, PHYLLIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:TONKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1707
Mailing Address - Country:US
Mailing Address - Phone:713-668-6666
Mailing Address - Fax:713-668-6663
Practice Address - Street 1:7500 SAN FELIPE ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1707
Practice Address - Country:US
Practice Address - Phone:713-668-6666
Practice Address - Fax:713-668-6663
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00929PMedicare PIN
TXP95068Medicare UPIN
TX6262763OtherUNOTED BEHAVIORAL HEALTH
TX7165056OtherAETNA
TXP95068Medicare UPIN
TX00929PMedicare PIN
TX0022KMOtherBLUE CROSS/BLUE SHIELD OF
TX176758401Medicaid