| NPI | 1891200911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCINDA MILLER-MANGROBANG Member Manager 907-885-1089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: AK 1062801) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AK 576) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 4965) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: AK 1062801) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 1364) | |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2023-01-16 |