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General NPI Number Information
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NPI Number | 1659581353
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Entity Type | Individual
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Provider Name | CALVIN J NEZ SR. LISAC, ICADC, SCB
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BUILDING NO 25
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 928-283-3031
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Fax | 928-283-3039
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Provider Business Mailing Address
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Address Line | PO BOX 3685
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City | TUBA CITY
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State | AZ
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Zip | 86045-3685
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Country | US
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Telephone | 928-283-6966
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-11030
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License Number State | AZ
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