1447684634 NPI number — ALASKA MARRIAGE & FAMILY THERAPY ASSOCIATES

Table of content: (NPI 1447684634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447684634 NPI number — ALASKA MARRIAGE & FAMILY THERAPY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALASKA MARRIAGE & FAMILY THERAPY ASSOCIATES
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:
1447684634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 E INTL AIRPORT RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99518-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-570-6382
Provider Business Mailing Address Fax Number:
888-972-3679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 E INTL AIRPORT RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99518-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-570-6382
Provider Business Practice Location Address Fax Number:
800-470-0580
Provider Enumeration Date:
08/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CLINICAL DIRECTOR / PSYCHOLOGIST
Authorized Official Telephone Number:
907-570-6382

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  988057 , 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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