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Highway 163-bldg-ka-2010 Kayenta AZ 86033-0368 | |
(928) 695-4000 | |
(928) 697-4189 |
Full Name | |
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Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
Location | Highway 163-bldg-ka-2010, Kayenta, Arizona |
Authorized Official Name and Position | Anna Boone (SUPERVISORY SOCIAL WORKER) |
Authorized Official Contact | 9286974185 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 368 Kayenta AZ 86033-0368 Ph: (928) 695-4000 | Highway 163-bldg-ka-2010 Kayenta AZ 86033-0368 Ph: (928) 695-4000 |
NPI Number | 1780878801 |
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Provider Enumeration Date | 08/31/2007 |
Last Update Date | 08/31/2007 |
Identifier | Type | State | Issuer |
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1780878801 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | LCSW-11436 (Arizona) | Primary |