Provider Demographics
NPI:1164588976
Name:HEAD, TAWN ELISE (MA,LPCC)
Entity Type:Individual
Prefix:MS
First Name:TAWN
Middle Name:ELISE
Last Name:HEAD
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 1:13145 NEON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4870
Mailing Address - Country:US
Mailing Address - Phone:505-315-8001
Mailing Address - Fax:505-293-8505
Practice Address - Street 1:13145 NEON AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4870
Practice Address - Country:US
Practice Address - Phone:505-315-8001
Practice Address - Fax:505-293-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0087381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health