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General NPI Number Information
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NPI Number | 1316129216
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Entity Type | Organization
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Legal Business Name | NEWLANDS OUTPATIENT TREATMENT CENTER
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 1/4 MILES SOUTH OF SANDERS HIGH SCHOOL, SHONDIIN STREET
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City | SANDERS
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State | AZ
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Zip | 86512-1086
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Country | US
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Telephone | 928-688-3475
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Fax | 928-688-3478
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Provider Business Mailing Address
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Address Line | PO BOX 1086
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City | SANDERS
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State | AZ
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Zip | 86512-1086
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Country | US
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Telephone | 928-688-3475
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Fax | 928-688-3478
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH DIRECTOR
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Name | MIRANDA BLATCHFORD
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Credential | LCSW
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Telephone | 928-688-3475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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