MEDICARE: JUSTIN L ULAK

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1386231710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN L ULAK

Provider Business Mailing Address
First Line	:	PO BOX 287
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559-0287
Country	:	US
Telephone Number	:	907-543-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 CALISTA DRIVE
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559-3333
Country	:	US
Telephone Number	:	907-538-9701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	12/31/2020

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