Healthcare Provider Details

I. General information

NPI: 1982341574
Provider Name (Legal Business Name): AMAZING LOVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 BADGER RD STE 205
NORTH POLE AK
99705-5710
US

IV. Provider business mailing address

PO BOX 55846
NORTH POLE AK
99705-0846
US

V. Phone/Fax

Practice location:
  • Phone: 907-651-8808
  • Fax:
Mailing address:
  • Phone: 907-651-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMELA EDWARDS
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, CMHC, NCC, LPC
Phone: 907-651-8808