Healthcare Provider Details

I. General information

NPI: 1699187161
Provider Name (Legal Business Name): CYNTHIA BARRAND BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREG KRUSCHECK
NOME AK
99762
US

IV. Provider business mailing address

1000 GREG KRUSCHECK
NOME AK
99762
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-9603
  • Fax: 907-443-8134
Mailing address:
  • Phone: 907-443-9603
  • Fax: 907-443-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: