Provider Demographics
NPI:1861180358
Name:TOLBERT, MONICA LETICIA (MC, MBH, LPC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LETICIA
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:MC, MBH, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 BACON RANCH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3380
Mailing Address - Country:US
Mailing Address - Phone:254-654-4529
Mailing Address - Fax:651-305-9283
Practice Address - Street 1:2403 BACON RANCH RD STE 300
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3380
Practice Address - Country:US
Practice Address - Phone:254-654-4529
Practice Address - Fax:651-305-9283
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85797101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty