Healthcare Provider Details

I. General information

NPI: 1063549764
Provider Name (Legal Business Name): BETTY BIZAHALONI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 4
PINON AZ
86510
US

IV. Provider business mailing address

PO DRAWER PH
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7001
  • Fax: 928-674-7705
Mailing address:
  • Phone: 928-674-7001
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-0384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: