Basic Information
| Provider Information | |||||||||
| NPI: | 1366657843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATATHLIE | ||||||||
| FirstName: | LEVON | ||||||||
| MiddleName: | OLIVIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX PH | ||||||||
| Address2: | |||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747166 | ||||||||
| FaxNumber: | 9286747705 | ||||||||
| Practice Location | |||||||||
| Address1: | NAVAJO ROUTE 4 | ||||||||
| Address2: | |||||||||
| City: | PINON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865100010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287253220 | ||||||||
| FaxNumber: | 9287253613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LISAC-10327 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | LMSW-11911 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.