Provider Demographics
NPI:1215379110
Name:ASAMOA-TUTU, SIERRA ROSE YAZZIE (LCSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE YAZZIE
Last Name:ASAMOA-TUTU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:ROSE
Other - Last Name:YAZZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH
Mailing Address - State:NM
Mailing Address - Zip Code:87322-0010
Mailing Address - Country:US
Mailing Address - Phone:612-670-3709
Mailing Address - Fax:
Practice Address - Street 1:3708 DULCE CT
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4524
Practice Address - Country:US
Practice Address - Phone:612-670-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224281041C0700X
NMC-117271041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health