ETHAN SHANE BLEVINS (NPI# 1164952966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164952966 |
| Entity Type | Individual |
| Full Name | ETHAN SHANE BLEVINS |
| Practice Address |
381 4th Ave Bethel AK 99559 |
| Mailing Address |
Po Box 528 Attn: Bh Bautista Bethel AK 99559 |
| Practice Telephone | 9075432242 |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2017-06-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 1020986 | 05 |
| Street Address |
381 4TH AVE |
| City | BETHEL |
| State | AK |
| Zip Code | 99559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902243629 | Ruth Bonnie Imgalrea | Counselor | 381 4th Ave, Bethel, AK 99559-3227 | 2013-06-04 |
| 1174137558 | Christian J Andrew | Counselor | 381 4th Ave, Bethel, AK 99559 | 2020-09-03 |
| 1831702315 | Dakota Sipary | Counselor | 381 4th Ave, Bethel, AK 99559 | 2020-08-25 |
| 1790394831 | Lauren Charles | Counselor | 381 4th Ave, Bethel, AK 99559 | 2020-07-24 |
| 1073081451 | Grant Ian Slats | Counselor | 381 4th Ave, Bethel, AK 99559 | 2018-11-05 |
| 1437625290 | Gloria Williams | Counselor | 381 4th Ave, Bethel, AK 99559 | 2018-10-19 |
| 1467949263 | Dorothy White | Case Manager/Care Coordinator | 381 4th Ave, Bethel, AK 99559 | 2018-04-17 |
| 1467959551 | Paul Joseph Hunter | Counselor | 381 4th Ave, Bethel, AK 99559 | 2018-04-06 |
| 1568997906 | John Perdue | Counselor | 381 4th Ave, Bethel, AK 99559-3227 | 2017-04-24 |
| 1649729260 | Iris Jasper | Counselor | 381 4th Ave, Bethel, AK 99559-3227 | 2016-09-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1003438508 | Enc Physical Therapy LLC | Physical Therapist | 223 Blackberry Street, Unit A, Bethel, AK 99559 | 2020-05-07 |
| 1780229609 | Laline Knox | Massage Therapist | 107 Alex Hatley Ste 1, Bethel, AK 99559 | 2019-11-14 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1639730484 | Jerri Linda Moran-gentle | Massage Therapist | 430 A 7th Ave, Bethel, AK 99559 | 2019-06-24 |
| 1528625381 | Jennifer Peeks | Social Worker | 631 4th Ave. & Main St., Bethel, AK 99559 | 2019-05-28 |
| 1710451190 | Mary Theresa Thibeault | Registered Nurse | Bethel Public Health Center, 1490 Eddie Hoffman Highway, Bethel, AK 99559 | 2019-01-18 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| Find all providers in zip 99559 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790395218 | Julia Rodriguez | Counselor | 1410 Calista Drve, Bethel, AK 99559-0528 | 2020-08-10 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1861048134 | Benjamin Agimuk | Counselor | 5016 Noel Polty, Bethel, AK 99559-1029 | 2019-08-13 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1568978799 | Shane Michael Polk | Counselor | 841 State Hwy, Bethel, AK 99559 | 2017-12-26 |
| 1568975357 | Carl Williams | Counselor | 833 Chieff Eddie Hoffman Hwy, Bethel, AK 99559 | 2017-11-15 |
| 1144746330 | Katelynn Rachele Greenwood | Counselor | 1360 Trestal Dr, Bethel, AK 99559 | 2017-08-18 |
| 1346770146 | Kimi Yatsushiro | Counselor | 829 Chief Eddie Hoffman Hightway, Bethel, AK 99559 | 2017-06-14 |
| 1144761677 | Sabrina Mignerey | Counselor | 4042 Oakland Rd, Bethel, OH 45106-8622 | 2017-03-16 |
| Find all providers in BETHEL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.