MARILYN YVONNE MACK (NPI# 1790967776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790967776 |
| Entity Type | Individual |
| Full Name | MARILYN YVONNE MACK |
| Practice Address |
829 Chief Eddie Hoffman Hwy Bethel AK 99559 |
| Mailing Address |
Po Box 528 Bethel AK 99559-0528 |
| Practice Telephone | 9075436800 |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MH0150 | 05 |
| Street Address |
829 CHIEF EDDIE HOFFMAN HWY |
| City | BETHEL |
| State | AK |
| Zip Code | 99559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679542484 | Peter Robert Hergenroether | Counselor | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2006-03-15 |
| 1376142174 | Thomasina Tishina Smith | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-10-22 |
| 1508478751 | Moses K Ayagalria Jr. | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-08-19 |
| 1720699044 | Reanna Jimmy | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-08-11 |
| 1891306387 | David Mochin | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-08-10 |
| 1396355053 | Lucy Ann Mochin | Counselor | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2020-08-06 |
| 1467074518 | Tawanda Moses | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hwy, Bethel, AK 99559 | 2020-05-12 |
| 1922635101 | Alice Lucy Leinberger | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hwy, Suite 327, Bethel, AK 99559-0528 | 2020-03-26 |
| 1700413663 | Erica Kameroff | Community Health Worker | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2020-03-23 |
| 1386283356 | D'angela Yvette Nickerson | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2019-12-23 |
| Find all providers in the same location | ||||
| 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 | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619588001 | Ashley Ann Stackowitz | Counselor | 1624 Lillieville Brook Rd, Bethel, VT 05032-9719 | 2020-08-11 |
| 1851714208 | William Lee Lockhart | Counselor | 1410 Calista Dr, Bethel, AK 99559 | 2014-01-21 |
| 1578909552 | Kristen L Cava | Counselor | 170 Old Hawleyville Rd, Bethel, CT 06801-3044 | 2013-05-16 |
| 1750655155 | Ledetra Bridges | Counselor | 381 4th Avenue, Bethel, AK 99559 | 2012-03-02 |
| 1023207503 | James Smash | Counselor | 5001 Noel Polty, Bethel, AK 99559 | 2007-10-19 |
| 1679763031 | Julie M Thompson | Counselor | 1410 Calista Drive, Bethel, AK 99559 | 2007-07-31 |
| 1134285935 | Stuart Beddie | Counselor | 48 Paradise Rd, Bethel, ME 04217-3601 | 2006-12-28 |
| 1891851499 | Joanna Prudden Drummond | Counselor | 36 Broad Street, Bethel, ME 04217 | 2006-12-28 |
| 1073961397 | Shar'ron Denorris Hardwell | Counselor | 1410 Calista Drive, Bethel, AK 99559 | 2016-05-26 |
| 1639550395 | Danielle Morgan Shawgo | Counselor | 829 Chief Eddie Hoffman Hwy, Suite 150, Bethel, AK 99559-0528 | 2015-06-17 |
| 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.