| Doctor Name: | LISA JOHN |
| NPI Number: | 1861686446 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LADAC |
| License Number: | 4575 |
| Business Practice Address: | Hwy 160 163 Blding Ka 2010 Kayenta, AZ - 860330368 |
| Business Phone Number: | 9286974185 |
| Business Fax Number: | 9286974189 |
| Mailing Address: | Po Box 368, KAYENTA |
| State: | AZ |
| Postal Code: | 860330368 |
| Phone Number: | 9286974185 |
| Fax Number: | 9286974189 |
| NPI Enumeration Date: | 08/28/2007 |
| NPI Last Update Date: | 08/28/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 4575 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |