Provider Demographics
NPI:1669120085
Name:TOLLIVER, ELIZABETH G (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:TOLLIVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4305
Mailing Address - Country:US
Mailing Address - Phone:304-216-3440
Mailing Address - Fax:
Practice Address - Street 1:2829 S 118TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4305
Practice Address - Country:US
Practice Address - Phone:304-216-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2024OtherLIMHP