Provider Demographics
NPI:1760092092
Name:DELOSSANTOS, TOMMIE JO
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:JO
Last Name:DELOSSANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TOMMIE
Other - Middle Name:JO
Other - Last Name:GILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5582 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-9474
Mailing Address - Country:US
Mailing Address - Phone:361-695-8226
Mailing Address - Fax:
Practice Address - Street 1:422 E AVENUE B
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-3311
Practice Address - Country:US
Practice Address - Phone:361-695-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health