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GREATLAND MENTAL HEALTH, LLC
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1477743532
Organizational Registrant:Organization Name: GREATLAND MENTAL HEALTH, LLC
Organization is not Subpart
Authorized Official: THERESA M RONCO BILLING MANAGER 907--63-27577
Organization is not Subpart
Authorized Official: THERESA M RONCO BILLING MANAGER 907--63-27577
Location and contact information for practice:
1407 W 31ST AVE STE 201 ANCHORAGE, AK 99503-3678 US
Tel: 907-929-4009 Fax: 907-929-4902
Tel: 907-929-4009 Fax: 907-929-4902
Contact information for business:
PO BOX 111810 ANCHORAGE, AK 99511-1810 US
Tel: 907-929-4009 Fax: 907-929-4902
Tel: 907-929-4009 Fax: 907-929-4902
Registration Information:
NPI: 1477743532
Entity Type: Organization
Entity Type: Organization
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | ||
| Y | 2084P0800X | Allopathic & Osteopathic Physicians Psychiatry & Neurology |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| MH3538 | AK | 05 |
