| Freedom Behavioral Health Alaska Llc | |
|
10928 Eagle River Rd Ste 254 Eagle River AK 99577-8080 | |
| (907) 696-0221 | |
| (877) 875-9556 |
| Full Name | Freedom Behavioral Health Alaska Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10928 Eagle River Rd Ste 254, Eagle River, Alaska |
| Authorized Official Name and Position | Kerry Clemetson (DIRECTOR OF BILLING/ CREDENTIALING) |
| Authorized Official Contact | 9134757713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Freedom Behavioral Health Alaska Llc 10928 Eagle River Rd Ste 254 Eagle River AK 99577-8080 Ph: (907) 696-0221 | Freedom Behavioral Health Alaska Llc 10928 Eagle River Rd Ste 254 Eagle River AK 99577-8080 Ph: (907) 696-0221 |
| NPI Number | 1003671348 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 4880033513 |
|---|---|
| Medicare Enrollment ID | O20240415002290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003671348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | David Wichman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760695290 PECOS PAC ID: 2062585805 Enrollment ID: I20240415002387 |
| Provider Name | Nathanael Lenz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043590979 PECOS PAC ID: 8527407774 Enrollment ID: I20240423001234 |
| Provider Name | Cynthia Barraza Guerra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578252417 PECOS PAC ID: 0840630083 Enrollment ID: I20240503003347 |
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