Provider Demographics
NPI:1407067135
Name:YAZZIE, VIRGINIA BECENTI (CMS)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:BECENTI
Last Name:YAZZIE
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NIZHONI BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5766
Mailing Address - Country:US
Mailing Address - Phone:505-722-9470
Mailing Address - Fax:505-722-9570
Practice Address - Street 1:300 W NIZHONI BLVD STE A
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5766
Practice Address - Country:US
Practice Address - Phone:505-722-9470
Practice Address - Fax:505-722-9570
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-119171M00000X, 171M00000X
NM0077951101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)