Healthcare Provider Details

I. General information

NPI: 1407449291
Provider Name (Legal Business Name): MICHAEL DONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK ROAD
DILLINGHAM AK
99576
US

IV. Provider business mailing address

PO BOX 795
DILLINGHAM AK
99576-0795
US

V. Phone/Fax

Practice location:
  • Phone: 972-533-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number193632
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: