Healthcare Provider Details

I. General information

NPI: 1346466232
Provider Name (Legal Business Name): YUKON KUSKOKWIM HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CHIEF EDDIE HOFFMAN HWY SUITE 340
BETHEL AK
99559
US

IV. Provider business mailing address

PO BOX 528
BETHEL AK
99559-0528
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6000
  • Fax: 907-543-6117
Mailing address:
  • Phone: 907-543-6000
  • Fax: 907-543-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL WINKELMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 907-543-6032