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General NPI Number Information
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NPI Number | 1750687919
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Entity Type | Individual
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Provider Name | MATILDA BEGAY LSAA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 45 PINSBAARI DRIVE
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City | ACOMA
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State | NM
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Zip | 87034
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Country | US
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Telephone | 505-552-6661
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Fax | 505-552-6426
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | ACOMA
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State | NM
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Zip | 87034
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Country | US
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Telephone | 505-552-6661
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Fax | 505-552-6426
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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 | 0187771
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License Number State | NM
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