Organization
TUBA CITY OUTPATIENT TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELL DICKSON M.A., M.ED., LPC (BEHAVIORAL HEALTH DIRECTOR)
(928) 657-8000
Entity
Organization
Contact information
Practice address
MAIN STREET BLDG. 25, TUBA CITY, AZ 86045-1350
(928) 283-3346
(928) 283-3039
Mailing address
PO BOX 1350, BLDG. 25 MAIN STREET, TUBA CITY, AZ 86045-1350
(928) 283-3346
(928) 283-3039
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329492
—
AZ
Enumeration date
04/06/2007
Last updated
03/10/2022
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