Healthcare Provider Details

I. General information

NPI: 1073388252
Provider Name (Legal Business Name): MELISSA WENTZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 LINCOLN ST STE 234
SITKA AK
99835-7676
US

IV. Provider business mailing address

403 LINCOLN ST STE 234
SITKA AK
99835-7676
US

V. Phone/Fax

Practice location:
  • Phone: 907-738-0462
  • Fax: 800-840-0692
Mailing address:
  • Phone: 907-738-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number232591
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: