Provider Demographics
NPI:1720899503
Name:TOLLEY, IVANNA ROSE
Entity type:Individual
Prefix:
First Name:IVANNA
Middle Name:ROSE
Last Name:TOLLEY
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:PO BOX 738554
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-8554
Mailing Address - Country:US
Mailing Address - Phone:346-500-5842
Mailing Address - Fax:
Practice Address - Street 1:8000 S LINCOLN ST STE 10
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2725
Practice Address - Country:US
Practice Address - Phone:346-500-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician