Healthcare Provider Details

I. General information

NPI: 1548706930
Provider Name (Legal Business Name): LISA POYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 11/09/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 160 & NAVAJO ROUTE 25 - RED MESA
TEEC NOS POS AZ
86514
US

IV. Provider business mailing address

HC 61 BOX 30
TEECNOSPOS AZ
86514
US

V. Phone/Fax

Practice location:
  • Phone: 928-656-5136
  • Fax: 928-656-5132
Mailing address:
  • Phone: 928-656-5136
  • Fax: 928-656-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11454
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: