Healthcare Provider Details

I. General information

NPI: 1699319319
Provider Name (Legal Business Name): GASTINEAU HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5594 AISEK STREET
JUNEAU AK
99801
US

IV. Provider business mailing address

5597 AISEK STREET
JUNEAU AK
99801-9522
US

V. Phone/Fax

Practice location:
  • Phone: 907-780-3044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY D AEMMER
Title or Position: ADMINISTRATIVE SERVICES DIRECTOR
Credential:
Phone: 907-780-3016