Healthcare Provider Details

I. General information

NPI: 1538230701
Provider Name (Legal Business Name): JADE ACUPUNCTURE AND BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 K ST
ANCHORAGE AK
99501-3329
US

IV. Provider business mailing address

626 K ST
ANCHORAGE AK
99501-3329
US

V. Phone/Fax

Practice location:
  • Phone: 907-243-3031
  • Fax: 907-243-3922
Mailing address:
  • Phone: 907-243-3031
  • Fax: 907-243-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number401
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003
License Number StateAK

VIII. Authorized Official

Name: PETER A COURTNAGE
Title or Position: OWNER
Credential: D.AC., PSY.D.
Phone: 907-243-3031