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General NPI Number Information
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NPI Number | 1982145785
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Entity Type | Organization
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Legal Business Name | NAVAJO DEPT. OF BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 491 PINON STREET
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City | SHIPROCK
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State | NM
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Zip | 87420-1830
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Country | US
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Telephone | 505-368-1438
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Fax | 505-368-1462
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Provider Business Mailing Address
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Address Line | PO BOX 1830 HWY 491 PINON STREET
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City | SHIPROCK
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State | NM
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Zip | 87420-1830
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Country | US
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Telephone | 505-368-1438
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Fax | 505-368-1462
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Authorized Official
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Title or Position | TRADITIONAL HEALER
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Name | HARRY CLARK JR.
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Credential |
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Telephone | 505-368-1438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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