Provider Demographics
NPI:1215379110
Name:ASAMOA-TUTU, SIERRA ROSE YAZZIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE YAZZIE
Last Name:ASAMOA-TUTU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:ROSE
Other - Last Name:YAZZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:2025 E AZTEC AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4803
Mailing Address - Country:US
Mailing Address - Phone:505-863-3120
Mailing Address - Fax:
Practice Address - Street 1:2025 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4803
Practice Address - Country:US
Practice Address - Phone:505-863-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-117271041C0700X
MN224281041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health