| Jason Brent Fedeli Professional Counseling Llc | |
|
9330 Vanguard Dr Ste 202 Anchorage AK 99507-5393 | |
| (907) 202-2527 | |
| Not Available |
| Full Name | Jason Brent Fedeli Professional Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 9330 Vanguard Dr Ste 202, Anchorage, Alaska |
| Authorized Official Name and Position | Jason B Fedeli (BUSINESS OWNER) |
| Authorized Official Contact | 9073151955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Brent Fedeli Professional Counseling Llc 9330 Vanguard Dr Ste 202 Anchorage AK 99507-5393 Ph: (907) 202-2527 | Jason Brent Fedeli Professional Counseling Llc 9330 Vanguard Dr Ste 202 Anchorage AK 99507-5393 Ph: (907) 202-2527 |
| NPI Number | 1013676055 |
|---|---|
| Provider Enumeration Date | 12/16/2021 |
| Last Update Date | 12/23/2024 |
| Certification Date | 12/23/2024 |
| Medicare PECOS PAC ID | 8921549221 |
|---|---|
| Medicare Enrollment ID | O20240925004446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013676055 | NPI | - | NPPES |
| 1013676055 | Other | AK | NPI II |
| 1724757 | Medicaid | AK | |
| 1724759 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jason Brent Fedeli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407199656 PECOS PAC ID: 2567800162 Enrollment ID: I20240402001220 |
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