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Registrant NPI Number: 1003426776

Individual Registrant:
Gender: F
Sole Proprietor

Location and contact information for practice:
41 SIS ST  NULATO, AK 99765-0056 US
Tel: 907-452-8251  Fax: --

Contact information for business:
PO BOX 65056  NULATO, AK 99765-0056 US
Tel: 907-452-8251  Fax: --

Registration Information:
NPI: 1003426776
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers

Legacy codes, insurance codes and state license numbers:



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