| NPI | 1043610892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH BEATY Billing Agent 907-770-2380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 935267) |
| Additional Taxonomies | 103T00000X Psychologist |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2015-05-07 |