Provider Demographics
NPI:1669944914
Name:ALTAHA, NOEL
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ALTAHA
Suffix:
Gender:F
Credentials:
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 803
Mailing Address - Street 2:
Mailing Address - City:FORT APACHE
Mailing Address - State:AZ
Mailing Address - Zip Code:85926-0803
Mailing Address - Country:US
Mailing Address - Phone:480-519-6392
Mailing Address - Fax:
Practice Address - Street 1:213 WEST BEARGRASS DRIVE
Practice Address - Street 2:
Practice Address - City:FORT APACHE
Practice Address - State:AZ
Practice Address - Zip Code:85926-0803
Practice Address - Country:US
Practice Address - Phone:480-519-6392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20757104100000X
NY104726-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker