Healthcare Provider Details

I. General information

NPI: 1730565045
Provider Name (Legal Business Name): CHUGACHMIUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 BRAGAW ST STE 110
ANCHORAGE AK
99508-3463
US

IV. Provider business mailing address

1840 BRAGAW STREET SUITE 110
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-4155
  • Fax: 907-563-2891
Mailing address:
  • Phone: 907-562-4155
  • Fax: 907-278-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateAK
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLEY BAKER
Title or Position: HEALTH SERVICES DIVISION DIRECTOR
Credential:
Phone: 907-562-4155