Provider Demographics
NPI:1811629033
Name:KOLLETTE TOLBERT, LLC
Entity Type:Organization
Organization Name:KOLLETTE TOLBERT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KOLLETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-437-0462
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962-0417
Mailing Address - Country:US
Mailing Address - Phone:361-437-0462
Mailing Address - Fax:361-214-2861
Practice Address - Street 1:17350 STATE HIGHWAY 249 STE 220-6454
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1147
Practice Address - Country:US
Practice Address - Phone:361-238-7355
Practice Address - Fax:361-214-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty