Healthcare Provider Details

I. General information

NPI: 1073678710
Provider Name (Legal Business Name): GEORGIA YUKIWMA P.H.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 264-HOPI HEALTH CARE CENTER
SECOND MESA AZ
86043-0068
US

IV. Provider business mailing address

PO BOX 2
KYKOTSMOVI AZ
86039-0002
US

V. Phone/Fax

Practice location:
  • Phone: 928-737-6300
  • Fax: 928-737-6333
Mailing address:
  • Phone: 928-737-6300
  • Fax: 928-737-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: