Organization
FORT DEFIANCE OUTPATIENT TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRANDA BLATCHFORD LCSW (BEHAVIORAL HEALTH DIRECTOR)
(928) 729-4012
Entity
Organization
Contact information
Practice address
.5 MILES SW OF THE FD FIELD HOUSE BLDG #6905, FORT DEFIANCE, AZ 86504-1490
(928) 729-4012
(928) 729-4200
Mailing address
PO BOX 1490, FORT DEFIANCE, AZ 86504-1490
(928) 729-4012
(928) 729-4200
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
—
329541
—
AZ
Enumeration date
04/26/2007
Last updated
03/10/2022
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