Provider Demographics
NPI:1417158858
Name:TOUTANT, DENNIS (PHD, RAS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:TOUTANT
Suffix:
Gender:M
Credentials:PHD, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 ARCHIBALD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5729
Mailing Address - Country:US
Mailing Address - Phone:909-989-9724
Mailing Address - Fax:909-989-0249
Practice Address - Street 1:9375 ARCHIBALD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5729
Practice Address - Country:US
Practice Address - Phone:909-989-9724
Practice Address - Fax:909-989-0249
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-Q0701081409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)