Healthcare Provider Details

I. General information

NPI: 1235051723
Provider Name (Legal Business Name): GARRIS J. TACHEENE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 WEST HIGHWAY 264 QUALITY INN OFFICE COMPLEX SUITE 203
WINDOW ROCK AZ
86515
US

IV. Provider business mailing address

PO BOX 2199
TUBA CITY AZ
86045-2199
US

V. Phone/Fax

Practice location:
  • Phone: 928-871-7673
  • Fax:
Mailing address:
  • Phone: 928-871-7673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-23096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: