Doctor Name: | THERESA TOLTH |
NPI Number: | 1982813127 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LSAA |
License Number: | 79291 |
Business Practice Address: | Southwest Highland Drive Crownpoint, NM - 873131144 |
Business Phone Number: | 5057862423 |
Business Fax Number: | 5057865442 |
Mailing Address: | Southwest Highland Drive, CROWNPOINT |
State: | NM |
Postal Code: | 873131144 |
Phone Number: | 5057862423 |
Fax Number: | 5057865442 |
NPI Enumeration Date: | 05/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 79291 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |