Healthcare Provider Details

I. General information

NPI: 1265044135
Provider Name (Legal Business Name): CAROLYN TOENNIGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 09/26/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CARLEN CT
LAS CRUCES NM
88001-2006
US

IV. Provider business mailing address

1801 CARLEN CT
LAS CRUCES NM
88001-2006
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-1979
  • Fax:
Mailing address:
  • Phone: 575-649-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN B TOENNIGES
Title or Position: SINGLE MEMBER
Credential: LCSW
Phone: 575-649-1979