| Kenai Peninsula Mental Health Llc | |
|
133 Smith Way Unit C Soldotna AK 99669-8077 | |
| (907) 531-6047 | |
| (907) 531-3886 |
| Full Name | Kenai Peninsula Mental Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 133 Smith Way Unit C, Soldotna, Alaska |
| Authorized Official Name and Position | Mary E Kuepper (OWNER/PROVIDER) |
| Authorized Official Contact | 9075316047 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenai Peninsula Mental Health Llc Po Box 2653 Soldotna AK 99669-2653 Ph: (907) 531-3886 | Kenai Peninsula Mental Health Llc 133 Smith Way Unit C Soldotna AK 99669-8077 Ph: (907) 531-6047 |
| NPI Number | 1588135776 |
|---|---|
| Provider Enumeration Date | 12/16/2018 |
| Last Update Date | 08/11/2021 |
| Certification Date | 08/11/2021 |
| Medicare PECOS PAC ID | 7012311921 |
|---|---|
| Medicare Enrollment ID | O20210813001078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588135776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Rona S Haberman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831389378 PECOS PAC ID: 2163501198 Enrollment ID: I20181027000144 |
| Provider Name | Jose Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871044743 PECOS PAC ID: 0345647640 Enrollment ID: I20210929002905 |
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