Provider Demographics
NPI:1992365118
Name:THOUIN, TANIS LOU
Entity Type:Individual
Prefix:DR
First Name:TANIS
Middle Name:LOU
Last Name:THOUIN
Suffix:
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 1:6375 E TANQUE VERDE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3863
Mailing Address - Country:US
Mailing Address - Phone:520-240-3599
Mailing Address - Fax:
Practice Address - Street 1:6375 E TANQUE VERDE RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3863
Practice Address - Country:US
Practice Address - Phone:520-240-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13308103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)