MEDICARE: CENTER FOR PSYCHOSOCIAL DEVELOPMENT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	51575D	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194859850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PSYCHOSOCIAL DEVELOPMENT INC

Provider Business Mailing Address
First Line	:	1410 RUDAKOF CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3106
Country	:	US
Telephone Number	:	907-646-0707
Fax Number	:	907-600-5124

Provider Business Practice Location Address
First Line	:	1410 RUDAKOF CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3106
Country	:	US
Telephone Number	:	907-646-0707
Fax Number	:	907-600-5124

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LORETTA ROWLEY-SIPPLE
Credential	:	LPC
Telephone Number	:	907-646-0707

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/04/2024

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Directions to “CENTER FOR PSYCHOSOCIAL DEVELOPMENT INC ” Practice Location

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