Provider Demographics
NPI:1841173804
Name:BLACK, TEMPEST JULIET (LCSW)
Entity type:Individual
Prefix:
First Name:TEMPEST
Middle Name:JULIET
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 S TRAIL OF THE WOODS ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6716
Mailing Address - Country:US
Mailing Address - Phone:903-744-0617
Mailing Address - Fax:
Practice Address - Street 1:13 S TRAIL OF THE WOODS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6716
Practice Address - Country:US
Practice Address - Phone:903-744-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-22962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health