| Thriveworks Clinical - Alaska Llc | |
|
670 W Fireweed Ln Ste 100 Anchorage AK 99503-2562 | |
| (855) 284-7483 | |
| Not Available |
| Full Name | Thriveworks Clinical - Alaska Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 670 W Fireweed Ln Ste 100, Anchorage, Alaska |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thriveworks Clinical - Alaska Llc Po Box 748465 Atlanta GA 30374-8465 Ph: (855) 284-7483 | Thriveworks Clinical - Alaska Llc 670 W Fireweed Ln Ste 100 Anchorage AK 99503-2562 Ph: (855) 284-7483 |
| NPI Number | 1295452845 |
|---|---|
| Provider Enumeration Date | 10/25/2022 |
| Last Update Date | 10/25/2022 |
| Certification Date | 10/25/2022 |
| Medicare PECOS PAC ID | 9234504655 |
|---|---|
| Medicare Enrollment ID | O20230417000826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295452845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jennifer Morton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003218538 PECOS PAC ID: 6002268588 Enrollment ID: I20240119003309 |
| Provider Name | Tonie Protzman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760075097 PECOS PAC ID: 1355793837 Enrollment ID: I20240119003355 |
| Provider Name | Noel Tyler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588179352 PECOS PAC ID: 6204288780 Enrollment ID: I20240610003684 |
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