Individual
DENNIS TOLLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6821 W MALDONADO RD, LAVEEN, AZ 85339-2679
(602) 682-7584
Mailing address
6821 W MALDONADO RD, LAVEEN, AZ 85339-2679
(602) 682-7584
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
3936
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
717697
AHCCCS
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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