Healthcare Provider Details

I. General information

NPI: 1720118524
Provider Name (Legal Business Name): TRICIA ATOIGUE LIZAMA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CHALAN SANTO PAPA REFELCTION CENTER SUITE 102
HAGATNA GU
96910-5172
US

IV. Provider business mailing address

REFLECTION CENTER 222 CHALAN SANTO PAPA SUITE 102
HAGATNA GU
96910-5172
US

V. Phone/Fax

Practice location:
  • Phone: 671-477-5715
  • Fax: 671-472-6221
Mailing address:
  • Phone: 671-477-5715
  • Fax: 671-477-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0000075
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: