Healthcare Provider Details

I. General information

NPI: 1215379110
Provider Name (Legal Business Name): SIERRA ROSE YAZZIE ASAMOA-TUTU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA ROSE YAZZIE MSW, LICSW

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 DULCE CT
GALLUP NM
87301-4524
US

IV. Provider business mailing address

PO BOX 10
REHOBOTH NM
87322-0010
US

V. Phone/Fax

Practice location:
  • Phone: 612-670-3709
  • Fax:
Mailing address:
  • Phone: 612-670-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22428
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11727
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: