=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235051723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARRIS J. TACHEENE LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2026
-----------------------------------------------------
Last Update Date | 07/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48 WEST HIGHWAY 264 QUALITY INN OFFICE COMPLEX SUITE 203
-----------------------------------------------------
City | WINDOW ROCK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-871-7673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2199
-----------------------------------------------------
City | TUBA CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86045-2199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-871-7673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-23096
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------