WILD GOOSE COUNSELING LLC (NPI# 1891224879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891224879 |
| Entity Type | Organization |
| Organization Name | WILD GOOSE COUNSELING LLC |
| Practice Address |
198 W Marydale Ave Soldotna AK 99669-7501 |
| Mailing Address |
379 W Katmai Ave Soldotna AK 99669-7315 |
| Practice Telephone | 9079539614 |
| Mailing Telephone | 9079539614 |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2017-06-05 |
| Authorized Official Name | LYDIA ANNA DAVIS (CO-OWNER) |
| Authorized Official Telephone | 9079539614 |
| Authorized Official Credential | LPC. MAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
AK | Ambulatory Health Care Facilities | |
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
AK | Ambulatory Health Care Facilities | |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
AK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | LICENSED PROFESSIONAL COUNSELOR MOLLY DAVIS | 109623 | 01 |
| AK | LICENSED PROFESSIONAL COUNSELOR LYDIA DAVIS | 109622 | 01 |
| Street Address |
198 W MARYDALE AVE |
| City | SOLDOTNA |
| State | AK |
| Zip Code | 99669-7501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477082410 | Lydia Anna Davis | Counselor | 198 W Marydale Ave, Soldotna, AK 99669-7501 | 2017-06-04 |
| 1376014860 | Precision Chiropractic LLC | Chiropractor | 198 W Marydale Ave, Soldotna, AK 99669-7501 | 2018-12-10 |
| 1487183059 | Debra Marie Kvasnikoff | Massage Therapist | 198 W Marydale Ave, Soldotna, AK 99669-7501 | 2017-06-07 |
| 1023547882 | Molly Gretchen Davis | Counselor | 198 W Marydale Ave, Soldotna, AK 99669-7501 | 2017-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881201226 | Kyle Arron Shassetz | Counselor | 43335 K-beach Rd., Soldotna, AK 99669 | 2020-09-29 |
| 1720614993 | Peninsula Instacare | Clinic/Center | 34581 Kenai Spur Hwy, Suite 1, Soldotna, AK 99669 | 2020-03-19 |
| 1871141077 | Alaine Viola Lagasse | Counselor | Kenai Vet Center, 43299 Kalifornsky Beach Road Ste 4, Soldotna, AK 99669 | 2019-08-30 |
| 1962970574 | Ryder R Storm | Behavior Technician | 338800 Community College Drive, Suite 1, Soldotna, AK 99669 | 2018-11-13 |
| 1356821540 | Tanecia Webster | Nurse Practitioner | 36570 Kenai Spur Hwy, Ste 103a, Soldotna, AK 99669 | 2018-08-16 |
| 1821519869 | Theresa Napolitano | Case Manager/Care Coordinator | 35477 Kenai Spur Hwy Suite 203, Soldotna, AK 99669 | 2017-06-29 |
| 1689048282 | Jeanne Bignell | Licensed Practical Nurse | 35020 Alaskan View Lane, Soldotna, AK 99669 | 2015-11-19 |
| 1952786105 | Ian Charles Mcmullen | Pharmacist | 44001 Sterling Highway, Soldotna, AK 99669 | 2015-07-29 |
| 1841679933 | Lana Clymer | Case Manager/Care Coordinator | 22994 Kalifornsky Beach Rd, Soldotna, AK 99669 | 2015-05-22 |
| 1861800773 | Phillip Bruce | Physical Therapy Assistant | 35105 Kenai Spury Hwy, Suite A, Soldotna, AK 99669 | 2014-07-24 |
| Find all providers in zip 99669 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528062429 | Central Peninsula General Hospital Inc. | Clinic/Center | 250 Hospital Pl, Soldotna, AK 99669-7559 | 2005-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002113 | Volunteers of America Alaska, Central Ms | Clinic/Center | 1405 E St, Anchorage, AK 99501-5047 | 2020-10-27 |
| 1811597065 | Volunteers of America Alaska, West Hs | Clinic/Center | 1700 Hillcrest Dr, Anchorage, AK 99517-1347 | 2020-10-27 |
| 1578163721 | Volunteers of America Alaska, Romig Ms | Clinic/Center | 2500 Minnesota Dr, Anchorage, AK 99503-2384 | 2020-10-27 |
| 1295335446 | Volunteers of America Alaska, Tyson Es | Clinic/Center | 2801 Richmond Ave, Anchorage, AK 99508-1099 | 2020-10-27 |
| 1407466204 | Southcentral Foundation | Clinic/Center | 11495 N Callison St, Sutton, AK 99674 | 2020-08-06 |
| 1972120210 | Denali Family Services | Clinic/Center | 291 E Swanson Ave, Wasilla, AK 99654-7004 | 2020-07-02 |
| 1063033959 | Volunteers of America Alaska, Bartlett Hs | Clinic/Center | 1101 Golden Bear Dr, Anchorage, AK 99504-6120 | 2020-05-01 |
| 1427679307 | Volunteers of America Alaska, Benny Ss | Clinic/Center | 4515 Campbell Airstrip Rd, Anchorage, AK 99507-1267 | 2020-05-01 |
| 1396366290 | Volunteers of America Alaska, East Hs | Clinic/Center | 4025 E Northern Lights Blvd, Anchorage, AK 99508-3588 | 2020-05-01 |
| 1558991323 | Hatcher Pass Counseling and Consultation LLC | Clinic/Center | 720 E Evergreen Ave Ste B, Palmer, AK 99645-6660 | 2020-01-21 |
| Find all providers with the same taxonomy | ||||
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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.