| Mitkof Behavioral Health | |
|
403 Haugen Drive #103 Petersburg AK 99833-0771 | |
| (907) 650-0222 | |
| (907) 772-3710 |
| Full Name | Mitkof Behavioral Health |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 403 Haugen Drive, Petersburg, Alaska |
| Authorized Official Name and Position | Kara B Wesebaum (OWNER) |
| Authorized Official Contact | 9076500222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mitkof Behavioral Health Po Box 771 Petersburg AK 99833-0771 Ph: (907) 650-0222 | Mitkof Behavioral Health 403 Haugen Drive #103 Petersburg AK 99833-0771 Ph: (907) 650-0222 |
| NPI Number | 1164191698 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 05/05/2022 |
| Certification Date | 04/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164191698 | NPI | - | NPPES |
| 99833 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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