| NPI | 1760064075 |
|---|---|
| Doing Business As | BRISTOL BAY COUNSELING CENTER MANOKOTAK CLINIC |
| Entity Type | Organization |
| Authorized Contact | CATHY LEEANN TAYLOR Provider Enrollment Specialist 907-842-5201 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-04-30 |