1982155081 NPI number — MS. ANDREA LYNN JOSHEVAMA M.ED.

Table of content: MS. ANDREA LYNN JOSHEVAMA M.ED. (NPI 1982155081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982155081 NPI number — MS. ANDREA LYNN JOSHEVAMA M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSHEVAMA
Provider First Name:
ANDREA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SECAKUKU
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982155081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 68
Provider Second Line Business Mailing Address:
THE HOPI TRIBE/HOPI GUIDANCE CENTER
Provider Business Mailing Address City Name:
SECOND MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-737-6300
Provider Business Mailing Address Fax Number:
928-737-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 264, MP 388
Provider Second Line Business Practice Location Address:
HOPI BEHAVIORAL HEALTH SERVICES
Provider Business Practice Location Address City Name:
POLACCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-737-6300
Provider Business Practice Location Address Fax Number:
928-737-6333
Provider Enumeration Date:
10/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  LISAC11792 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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