Provider Demographics
NPI:1568673051
Name:TODAKONZIE, BARBARA (LISAC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:TODAKONZIE
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-1490
Mailing Address - Country:US
Mailing Address - Phone:928-729-4012
Mailing Address - Fax:928-729-4200
Practice Address - Street 1:NAVAJO NATION RESERVATION
Practice Address - Street 2:300 YARDS SOUTH OF FORT DEFIANCE FIELDHOUSE
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-1490
Practice Address - Country:US
Practice Address - Phone:928-729-4012
Practice Address - Fax:928-729-4200
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11372101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329541-01Other1