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NPI Code Detail

MEDICARE: TONILYN SKATER MC

MEDICARE: TONILYN SKATER MC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLISAC - 11659AZ
2101YM0800XMental Health CounselorLPC 12831AZ

General Provider Information

NPI Number : 1770519308
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONILYN SKATER MC
Provider Business Mailing Address
First Line : 4949 S. PARK AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85714-2005
Country : US
Telephone Number : 520-333-4320
Fax Number : 520-207-0542
Provider Business Practice Location Address
First Line : 3939 S PARK AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85714-1635
Country : US
Telephone Number : 520-333-4320
Fax Number : 520-207-0542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2006
Last Update Date : 12/05/2014

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Directions to “ TONILYN SKATER MC” Practice Location

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