Provider Demographics
NPI:1588360721
Name:TOLMAIS, DANIELLE SULTANA (NONE)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SULTANA
Last Name:TOLMAIS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7522 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2104
Mailing Address - Country:US
Mailing Address - Phone:314-532-0544
Mailing Address - Fax:573-874-1723
Practice Address - Street 1:7522 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2104
Practice Address - Country:US
Practice Address - Phone:314-532-0544
Practice Address - Fax:573-874-1723
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO00017419106S00000X
MO2023040658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician