Healthcare Provider Details

I. General information

NPI: 1891465316
Provider Name (Legal Business Name): DEWAYNE BEGAY LACT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E CEDAR AVE STE 26
FLAGSTAFF AZ
86004-1642
US

IV. Provider business mailing address

3601 S LAKE MARY RD APT 209
FLAGSTAFF AZ
86005-9214
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-1245
  • Fax: 928-773-9429
Mailing address:
  • Phone: 928-679-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLACT-15206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: