Provider Demographics
NPI:1548462047
Name:LA TURNER, TINA C (MA LPCC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:C
Last Name:LA TURNER
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 VISTA SIERRA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2651
Mailing Address - Country:US
Mailing Address - Phone:505-610-9985
Mailing Address - Fax:888-801-4244
Practice Address - Street 1:4601 PARADISE BLVD NW
Practice Address - Street 2:SUITE 113
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6074
Practice Address - Country:US
Practice Address - Phone:505-610-9985
Practice Address - Fax:888-801-4244
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0093691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98988832Medicaid