Healthcare Provider Details

I. General information

NPI: 1922569540
Provider Name (Legal Business Name): HYDABURG CITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOTEM PARK LANE
HYDABURG AK
99922-9992
US

IV. Provider business mailing address

PO BOX 109
HYDABURG AK
99922-0109
US

V. Phone/Fax

Practice location:
  • Phone: 907-401-3359
  • Fax: 907-285-3391
Mailing address:
  • Phone: 907-401-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE ROY KIRCHNER JR.
Title or Position: COUNSELOR
Credential: LPC
Phone: 907-590-0931