Provider Demographics
NPI:1235957812
Name:YOUR STORY PLLC
Entity type:Organization
Organization Name:YOUR STORY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-791-5614
Mailing Address - Street 1:3801 SOUTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5079
Mailing Address - Country:US
Mailing Address - Phone:254-394-0976
Mailing Address - Fax:
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:254-791-5614
Practice Address - Fax:651-305-9283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty