Provider Demographics
NPI:1831397488
Name:NAVAJO NATION CROWNPOINT OUTPATIENT TREATMENT CENTER
Entity type:Organization
Organization Name:NAVAJO NATION CROWNPOINT OUTPATIENT TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-786-2128
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-1144
Mailing Address - Country:US
Mailing Address - Phone:505-786-2128
Mailing Address - Fax:505-786-2020
Practice Address - Street 1:SW HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313
Practice Address - Country:US
Practice Address - Phone:505-786-2128
Practice Address - Fax:505-786-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32279752Medicaid