Provider Demographics
NPI:1750687919
Name:BEGAY, MATILDA (LSAA)
Entity Type:Individual
Prefix:MS
First Name:MATILDA
Middle Name:
Last Name:BEGAY
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:MATILDA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSAA
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:505-552-6426
Practice Address - Street 1:45 PINSBAARI DRIVE
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:505-552-6426
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0187771101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)