1497105126 NPI number — PRINCILLA PATRICE URSERY LPC

Table of content: PRINCILLA PATRICE URSERY LPC (NPI 1497105126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497105126 NPI number — PRINCILLA PATRICE URSERY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URSERY
Provider First Name:
PRINCILLA
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

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:
1497105126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTA JUNCTION
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99737-0472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-987-6052
Provider Business Mailing Address Fax Number:
866-898-9031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3590 HOLDEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-456-6445
Provider Business Practice Location Address Fax Number:
866-898-9031
Provider Enumeration Date:
06/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  172683 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 6401017280 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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