Provider Demographics
NPI:1487481636
Name:HARRISON-TOLIVER, SHENETHA
Entity type:Individual
Prefix:
First Name:SHENETHA
Middle Name:
Last Name:HARRISON-TOLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14915 ASHLEY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4690
Mailing Address - Country:US
Mailing Address - Phone:713-205-6602
Mailing Address - Fax:
Practice Address - Street 1:14915 ASHLEY CREEK CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4690
Practice Address - Country:US
Practice Address - Phone:713-205-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator