1356551063 NPI number — TOK AREA MENTAL HEALTH COUNCIL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356551063 NPI number — TOK AREA MENTAL HEALTH COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOK AREA MENTAL HEALTH COUNCIL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TOK AREA COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356551063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 398
Provider Second Line Business Mailing Address:
W.1ST ST SUITE 8
Provider Business Mailing Address City Name:
TOK
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99780-0398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-883-5106
Provider Business Mailing Address Fax Number:
907-883-5108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W.1ST STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
TOK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99780-0398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-883-5106
Provider Business Practice Location Address Fax Number:
907-883-5108
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOWERY
Authorized Official First Name:
ORA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTORS
Authorized Official Telephone Number:
907-883-5855

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  183290 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 183290 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 183290 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MH0285 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: TAM84686 . This is a "STATE OF AK VENDOR ID #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 183290 . This is a "ALASKA BUSINESS LICENSE #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 20456D . This is a "DCCED CBPL AK ENTITY #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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