Provider Demographics
NPI:1053590604
Name:JOLIVETTE, SADIE BELL (LPC)
Entity type:Individual
Prefix:MS
First Name:SADIE
Middle Name:BELL
Last Name:JOLIVETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19907 MASON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7491
Mailing Address - Country:US
Mailing Address - Phone:832-790-7629
Mailing Address - Fax:281-855-4063
Practice Address - Street 1:19907 MASON CREEK DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7491
Practice Address - Country:US
Practice Address - Phone:832-790-7629
Practice Address - Fax:281-855-4063
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187255801Medicaid