Provider Demographics
NPI:1477259703
Name:DANA, STEVEN (MSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DANA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-9589
Mailing Address - Country:US
Mailing Address - Phone:928-369-6929
Mailing Address - Fax:
Practice Address - Street 1:550 NORTH BUTLER STREET
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925
Practice Address - Country:US
Practice Address - Phone:928-333-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6670810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23399895Medicaid