PROVIDENCE KODIAK ISLAND COUNSELING CENTER (NPI# 1376141929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376141929 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE KODIAK ISLAND COUNSELING CENTER |
| Practice Address |
717 E Rezanof Dr Kodiak AK 99615-6416 |
| Mailing Address |
Po Box 3290 Portland OR 97208-3290 |
| Practice Telephone | 9074812400 |
| Practice Fax Number | 9074812419 |
| Mailing Telephone | 9074812000 |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2020-10-15 |
| Authorized Official Name | DONALD W ANDERSON JR. (ASST SEC FOR ENROLLENT/DIR REIMB) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093147589 | Providence Kodiak Island Counseling Center | Case Management | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2013-08-06 |
| Street Address |
717 E REZANOF DR |
| City | KODIAK |
| State | AK |
| Zip Code | 99615-6416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477563344 | Providence Health & Services Washington | Psychiatry & Neurology | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2006-08-09 |
| 1467079442 | Alexandra S Woodside | Counselor | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2020-06-25 |
| 1295365732 | Kimberly Katelnikoff | Case Manager/Care Coordinator | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2020-01-23 |
| 1518507029 | Starr Shanley | Case Manager/Care Coordinator | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2020-01-13 |
| 1265915193 | Christine L Foster | Counselor | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2018-09-06 |
| 1285115832 | Laura Lynette Griffin | Case Manager/Care Coordinator | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2018-08-22 |
| 1679053391 | Cynthia Clogston | Case Manager/Care Coordinator | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2018-08-21 |
| 1104310200 | Stephanie M Mccarter | Counselor | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2018-06-21 |
| 1124545991 | Maria Theresa Vitor Cabrera | Registered Nurse | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2017-08-23 |
| 1235676545 | Pureza Villaran | Case Manager/Care Coordinator | 717 E Rezanof Dr, Kodiak, AK 99615-6416 | 2017-01-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144864232 | Linda Irene Dunlap | Spec/Tech, Pathology | 1915 E. Remanof Drive, Kodiak, AK 99615 | 2019-10-31 |
| 1639638190 | Stephanie Brenteson | Community Health Worker | 125 Airport Way, Akhiok, AK 99615 | 2019-03-14 |
| 1609351022 | Desiree Alexis Wheeler | Optometrist | 3450 E Rezanof Dr, Kodiak, AK 99615 | 2018-10-02 |
| 1417479072 | Elaine Loomis Olsen | Case Manager/Care Coordinator | 1111 Purtov St., Kodiak, AK 99615 | 2017-07-14 |
| 1750828414 | Mary Jean Francisco | Case Manager/Care Coordinator | 717 East Rezanof Drive, Kodiak, AK 99615 | 2017-01-19 |
| 1558818112 | Carolyn Hawes | Case Manager/Care Coordinator | 717 Rezanof Dr, Kodiak, AK 99615 | 2016-09-01 |
| 1285083683 | Amanda Wilson | Community Health Worker | 124 Akhiok Street, Akhiok, AK 99615 | 2016-06-07 |
| 1447612056 | Kailee Champion | Massage Therapist | 3449 Rezanof Drive East, Kodiak, AK 99615 | 2016-03-23 |
| 1376891069 | Krystyna Mcrobert | Technician, Other | Cape Sarichef Road Bldg N46, Rockmore King Clinic, Kodiak, AK 99615 | 2012-08-28 |
| 1164778619 | Mark Anthony Johnson | Pharmacist | 3449 Rezanof Drive, Kodiak, AK 99615 | 2012-08-01 |
| Find all providers in zip 99615 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700483781 | Anchorage Community Mental Health Services, Inc | Community/Behavioral Health | 704 W 26th Ave, Anchorage, AK 99503-2532 | 2020-10-03 |
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1124646641 | Alaska Art Therapy and Counseling | Community/Behavioral Health | 1107 W 8th St Unit 5, Juneau, AK 99801-1853 | 2020-07-10 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1316561509 | Juneau Youth Services, Inc. | Community/Behavioral Health | 1507 3rd St, Douglas, AK 99824 | 2020-06-03 |
| 1225652407 | Juneau Youth Services, Inc. | Community/Behavioral Health | 1600 Renninger St, Juneau, AK 99801 | 2020-06-03 |
| 1316561590 | Juneau Youth Services, Inc. | Community/Behavioral Health | 2901 Riverside Dr, Juneau, AK 99801 | 2020-06-03 |
| 1366066540 | Juneau Youth Services, Inc. | Community/Behavioral Health | 3400 Tongass Blvd, Juneau, AK 99801 | 2020-06-03 |
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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.