Healthcare Provider Details

I. General information

NPI: 1992154850
Provider Name (Legal Business Name): TONYA LOUIS MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COUGAR ROAD
SAN FELIPE NM
87001
US

IV. Provider business mailing address

PO BOX 4339
SAN FELIPE NM
87001
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-9928
  • Fax:
Mailing address:
  • Phone: 505-867-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08503
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: