Provider Demographics
NPI:1992154850
Name:LOUIS, TONYA (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4339
Mailing Address - Street 2:
Mailing Address - City:SAN FELIPE
Mailing Address - State:NM
Mailing Address - Zip Code:87001
Mailing Address - Country:US
Mailing Address - Phone:505-867-6166
Mailing Address - Fax:
Practice Address - Street 1:25 COUGAR ROAD
Practice Address - Street 2:
Practice Address - City:SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001
Practice Address - Country:US
Practice Address - Phone:505-639-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-085031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical