Healthcare Provider Details

I. General information

NPI: 1407066749
Provider Name (Legal Business Name): CECILIE DAWN CODY MAAT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 1ST AVENUE
KETCHIKAN AK
99901
US

IV. Provider business mailing address

PO BOX 7475
KETCHIKAN AK
99901
US

V. Phone/Fax

Practice location:
  • Phone: 907-202-8741
  • Fax: 907-202-8741
Mailing address:
  • Phone: 907-225-4664
  • Fax: 907-885-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCOP584
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0101611
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCOP584
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: