Healthcare Provider Details

I. General information

NPI: 1730834110
Provider Name (Legal Business Name): L JENAE MACNAUGHTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W NORTHERN LIGHTS BLVD STE 91196
ANCHORAGE AK
99517-3315
US

IV. Provider business mailing address

PO BOX 91196
ANCHORAGE AK
99509-1196
US

V. Phone/Fax

Practice location:
  • Phone: 844-414-6737
  • Fax: 877-560-9702
Mailing address:
  • Phone: 844-414-6737
  • Fax: 877-560-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: L JENAE R MACNAUGHTON
Title or Position: OWNER
Credential: LPC, LMHC
Phone: 844-414-6737