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General NPI Number Information
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NPI Number | 1558377796
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Entity Type | Individual
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Provider Name | JOHNA C HARTNELL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 10 NORTH RIVER ROAD PHS INDIAN HEALTH SERVICE
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City | FORT YATES
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State | ND
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Zip | 58538-0797
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Country | US
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Telephone | 701-854-3831
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Fax | 701-854-3844
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Provider Business Mailing Address
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Address Line | PO BOX J PHS INDIAN HEALTH SERVICE, DIR. BEHAVIORAL HEALTH
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City | FORT YATES
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State | ND
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Zip | 58538-0527
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Country | US
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Telephone | 701-854-8276
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Fax | 701-854-3844
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1129
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1116-57
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0035
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License Number State | NM
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