Healthcare Provider Details

I. General information

NPI: 1356835144
Provider Name (Legal Business Name): ELIZABETH SEWELL LPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CUSHMAN ST STE 4D
FAIRBANKS AK
99701-4665
US

IV. Provider business mailing address

PO BOX 72206
FAIRBANKS AK
99707-2206
US

V. Phone/Fax

Practice location:
  • Phone: 907-888-2665
  • Fax: 907-921-5133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: