Sierra Rose Yazzie Asamoa-Tutu, LCSW
Individual provider Active NPI Clinical Social Worker · Gallup, NM
NPI 1215379110 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1215379110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C-11727 (NM)
- Practice address
- 3708 Dulce CT
Gallup, NM 87301-4524 - Phone
- (612) 670-3709
- NPI assigned
- Jul 22, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210802000143 | NM | Practitioner - Clinical Social Worker | 5193129989 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22428 | MN | MD | Clinical Social Worker |
| C-11727 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tribalights Inc | Current |
Accepting new patients |
Locations
20 Road 2050
Aztec, NM 87410
Phone (310) 721-4398
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22428 | MN | |
| Clinical Social Worker | 1041C0700X | C-11727 | NM | Yes |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
3708 Dulce CT
Gallup, NM 87301-4524
Mailing address
PO Box 10
Rehoboth, NM 87322-0010
Phone (612) 670-3709
Other practice location 1
1316 Apache Ave
Santa Fe, NM 87505-3212
Phone (310) 721-4398
Other names
- Sierra Rose Yazzie
Other providers in Gallup, NM
- Nichole Larice Arthur
- Angela Arviso
- Anthony Lionel Arviso
- Tyler-Brooks Arviso
- Fernando Javier Arzola
- Alyssa Ashley
- Amber Dawn Ashley
- Carole Ashley
- Clarice Ashley
- Melissa Ashley
All providers in Gallup, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.