Provider Demographics
NPI:1033434832
Name:JOE, SHERRI ANN (LISAC)
Entity Type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:ANN
Last Name:JOE
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 777
Mailing Address - Street 2:NAVAJO ROUTE 7 & BIA ROUTE 102.1
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-674-2268
Mailing Address - Fax:928-674-2191
Practice Address - Street 1:ROUTE 7
Practice Address - Street 2:ROUTE 7
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86507
Practice Address - Country:US
Practice Address - Phone:928-674-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11492101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)