Provider Demographics
NPI:1053512673
Name:TOADLENA, MARTHA N (LISAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:N
Last Name:TOADLENA
Suffix:
Gender:F
Credentials:LISAC
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 744
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512-0744
Mailing Address - Country:US
Mailing Address - Phone:928-729-4349
Mailing Address - Fax:928-729-4097
Practice Address - Street 1:OLD COMMUNITY HEALTH BLDG
Practice Address - Street 2:
Practice Address - City:FT. DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-1490
Practice Address - Country:US
Practice Address - Phone:928-729-4349
Practice Address - Fax:928-729-4097
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11591101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)