| Fort Defiance Outpatient Treatment Center | |
|
.5 Miles Sw Of The Fd Field House Bldg #6905 Fort Defiance AZ 86504-1490 | |
| (928) 729-4012 | |
| (928) 729-4200 |
| Full Name | Fort Defiance Outpatient Treatment Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | .5 Miles Sw Of The Fd Field House Bldg #6905, Fort Defiance, Arizona |
| Authorized Official Name and Position | Miranda Blatchford (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Contact | 9287294012 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Defiance Outpatient Treatment Center Po Box 1490 Fort Defiance AZ 86504-1490 Ph: (928) 729-4012 | Fort Defiance Outpatient Treatment Center .5 Miles Sw Of The Fd Field House Bldg #6905 Fort Defiance AZ 86504-1490 Ph: (928) 729-4012 |
| NPI Number | 1740400365 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 03/10/2022 |
| Certification Date | 03/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740400365 | NPI | - | NPPES |
| 329541 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |