Provider Demographics
NPI:1457572323
Name:TOENNIS, MARK ANTHONY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:TOENNIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 AVENEL PL
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1800
Mailing Address - Country:US
Mailing Address - Phone:859-441-2236
Mailing Address - Fax:
Practice Address - Street 1:4150 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-3501
Practice Address - Country:US
Practice Address - Phone:859-442-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X, 103TH0100X
KY0873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00005490061OtherAETNA
KY000000001623OtherANTHEM
KY10654346857OtherHUMANA
KY10654346857OtherHUMANA