Healthcare Provider Details

I. General information

NPI: 1356551063
Provider Name (Legal Business Name): TOK AREA MENTAL HEALTH COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W.1ST STREET SUITE 8
TOK AK
99780-0398
US

IV. Provider business mailing address

PO BOX 398 W.1ST ST SUITE 8
TOK AK
99780-0398
US

V. Phone/Fax

Practice location:
  • Phone: 907-883-5106
  • Fax: 907-883-5108
Mailing address:
  • Phone: 907-883-5106
  • Fax: 907-883-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number183290
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number183290
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number183290
License Number StateAK

VIII. Authorized Official

Name: MR. ORA L LOWERY
Title or Position: DIRECTORS
Credential: M.A. LPC.,DI
Phone: 907-883-5855