Healthcare Provider Details

I. General information

NPI: 1669608337
Provider Name (Legal Business Name): TAWNYA HEINEKEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 113
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

1990 E LOHMAN AVE STE 113
LAS CRUCES NM
88001-3172
US

V. Phone/Fax

Practice location:
  • Phone: 575-312-0668
  • Fax:
Mailing address:
  • Phone: 575-312-0668
  • Fax: 575-524-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0201131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: