Provider Demographics
NPI:1699046649
Name:TOVALIN, TEODORO JR (BACHELORS)
Entity type:Individual
Prefix:
First Name:TEODORO
Middle Name:
Last Name:TOVALIN
Suffix:JR
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BROOK COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-0847
Mailing Address - Country:US
Mailing Address - Phone:702-413-4345
Mailing Address - Fax:
Practice Address - Street 1:6520 BROOK COTTAGE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-0847
Practice Address - Country:US
Practice Address - Phone:702-413-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling