Provider Demographics
NPI:1679032858
Name:TOLLIVER, GEORWANA (BCBA)
Entity Type:Individual
Prefix:
First Name:GEORWANA
Middle Name:
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 CYPRESS CORNER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-1132
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:
Practice Address - Street 1:2656 S LOOP W STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2772
Practice Address - Country:US
Practice Address - Phone:281-786-4234
Practice Address - Fax:713-583-7597
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX5304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician