| Providence Kodiak Island Counseling Center | |
|
1818 E Rezanof Dr Kodiak AK 99615-6505 | |
| (907) 481-2400 | |
| (907) 481-2419 |
| Full Name | Providence Kodiak Island Counseling Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1818 E Rezanof Dr, Kodiak, Alaska |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY OF ENROLLMENTS) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Kodiak Island Counseling Center Po Box 3290 Portland OR 97208-3290 Ph: (907) 486-9500 | Providence Kodiak Island Counseling Center 1818 E Rezanof Dr Kodiak AK 99615-6505 Ph: (907) 481-2400 |
| NPI Number | 1477563344 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/16/2024 |
| Medicare PECOS PAC ID | 0547152217 |
|---|---|
| Medicare Enrollment ID | O20040326001151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477563344 | NPI | - | NPPES |
| MH 2237 & DA2237 | Medicaid | AK |
| Provider Name | Ronnie B Burns |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629027222 PECOS PAC ID: 0648293894 Enrollment ID: I20110818000830 |
| Provider Name | Matthew J Wadsworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972759017 PECOS PAC ID: 4981733516 Enrollment ID: I20161219000337 |
| Provider Name | Belinda K Chambers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952567828 PECOS PAC ID: 9739243791 Enrollment ID: I20210601001128 |
| Provider Name | Amber Wellner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215601877 PECOS PAC ID: 1153728282 Enrollment ID: I20210916000967 |
| Provider Name | Jennifer M Newman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124799556 PECOS PAC ID: 2668867193 Enrollment ID: I20220321001680 |
| Provider Name | Clancy Halsted |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043837446 PECOS PAC ID: 0840679486 Enrollment ID: I20220628001128 |
| Provider Name | Carolyn Claire Craig |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598225351 PECOS PAC ID: 4385973056 Enrollment ID: I20230824004034 |
| Provider Name | Tahnee R King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740063064 PECOS PAC ID: 4183087372 Enrollment ID: I20230906001969 |
| Provider Name | Brandy Stratman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730347253 PECOS PAC ID: 9830546357 Enrollment ID: I20231106001025 |
| Provider Name | James M Price |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821421173 PECOS PAC ID: 4486005543 Enrollment ID: I20240112002740 |
| Provider Name | Edmore Mangena |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629291422 PECOS PAC ID: 7911358072 Enrollment ID: I20240112002787 |
| Provider Name | Kyra A Meyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831973783 PECOS PAC ID: 8224481304 Enrollment ID: I20240124004158 |
| Provider Name | Janna Harvey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518584267 PECOS PAC ID: 7517304082 Enrollment ID: I20240319003447 |
Mcnerney Enterprises Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1944 E Rezanof Dr, Kodiak, AK 99615 Phone: 907-942-1986 | |
Foreman Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1944 E Rezanof Dr, Kodiak, AK 99615 Phone: 907-654-9653 | |
Providence Kodiak Island Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 717 E Rezanof Dr, Kodiak, AK 99615 Phone: 907-481-2400 Fax: 907-481-2419 | |
Ken Mccarty, Lmft Discovery Cove Recovery & Wellness Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2975 Mill Bay Rd., Suite B, Kodiak, AK 99615 Phone: 907-487-2223 Fax: 907-487-2229 |