Provider Demographics
NPI:1679866644
Name:LUDINGTON, TAUSHA RENEE I
Entity Type:Individual
Prefix:MS
First Name:TAUSHA
Middle Name:RENEE
Last Name:LUDINGTON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 COUNTY ROAD 2400
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-9308
Mailing Address - Country:US
Mailing Address - Phone:970-759-3217
Mailing Address - Fax:
Practice Address - Street 1:99 COUNTY ROAD 2400
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9308
Practice Address - Country:US
Practice Address - Phone:970-759-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health