Provider Demographics
NPI:1770519308
Name:SKATER, TONILYN (MC)
Entity type:Individual
Prefix:
First Name:TONILYN
Middle Name:
Last Name:SKATER
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:TONILYN
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4949 S. PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-2005
Mailing Address - Country:US
Mailing Address - Phone:520-333-4320
Mailing Address - Fax:520-207-0542
Practice Address - Street 1:3939 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1635
Practice Address - Country:US
Practice Address - Phone:520-333-4320
Practice Address - Fax:520-207-0542
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC - 11659101YA0400X
AZLPC 12831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health