Provider Demographics
NPI:1174849582
Name:TSOSIE, HARRY D (LISAC)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:D
Last Name:TSOSIE
Suffix:
Gender:M
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0777
Mailing Address - Country:US
Mailing Address - Phone:928-674-2190
Mailing Address - Fax:928-674-2191
Practice Address - Street 1:NAVAJO ROUTE 7 AND BIA ROUTE 102.1 (CO12-118
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-2190
Practice Address - Fax:928-674-2191
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11401101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)