| NPI | 1346585056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE CARLLSON RN 907-543-6106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: AK NUR R 27765) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: AK NUR R 27765) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2012-12-06 |