Provider Demographics
NPI:1982145785
Name:NAVAJO DEPT. OF BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:NAVAJO DEPT. OF BEHAVIORAL HEALTH SERVICES
Other - Org Name:NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:TRADITIONAL HEALER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:505-368-1438
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:HWY 491 PINON STREET
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1438
Mailing Address - Fax:505-368-1462
Practice Address - Street 1:491 PINON STREET
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children