Provider Demographics
NPI:1750730826
Name:TOURANGEAU, JOHN MICHAEL (LCSW, LADAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:TOURANGEAU
Suffix:
Gender:M
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:HOLMAN
Mailing Address - State:NM
Mailing Address - Zip Code:87723-0007
Mailing Address - Country:US
Mailing Address - Phone:505-429-0905
Mailing Address - Fax:505-425-2913
Practice Address - Street 1:3168 STATE HIGHWAY 518
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NM
Practice Address - Zip Code:87715-2003
Practice Address - Country:US
Practice Address - Phone:505-429-0905
Practice Address - Fax:575-387-5260
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0203391101YA0400X
NMC-42481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM49084364Medicaid