Individual
SUZANNE TELLEZ DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
463 S LAKE POWELL BLVD, PAGE, AZ 86040-0856
(928) 645-5113
Mailing address
PO BOX 790, PAGE, AZ 86040-0790
(928) 433-3732
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22052
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22052
LCSW LICENSE
AZ
Enumeration date
03/25/2024
Last updated
03/25/2024
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