1033279351 NPI number — RACHEL A KACSUR LCSW

Table of content: TINA SHIHUA ZHANG PHARMD (NPI 1346096419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033279351 NPI number — RACHEL A KACSUR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RACHEL A KACSUR LCSW
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:
Provider Other Organization Name Type Code:
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:
1033279351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70394
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99707-0394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-455-0250
Provider Business Mailing Address Fax Number:
907-455-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 207B
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-455-0250
Provider Business Practice Location Address Fax Number:
907-455-0250
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KACSUR
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
907-455-0250

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  141 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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