Healthcare Provider Details

I. General information

NPI: 1215598677
Provider Name (Legal Business Name): LYNDEN CAROLA GROTHE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 W 2ND AVE
ANCHORAGE AK
99501-2031
US

IV. Provider business mailing address

PO BOX 111024
ANCHORAGE AK
99511-1024
US

V. Phone/Fax

Practice location:
  • Phone: 907-529-3699
  • Fax:
Mailing address:
  • Phone: 907-529-3699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number212821
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: