Healthcare Provider Details

I. General information

NPI: 1184454407
Provider Name (Legal Business Name): NATHAN MAYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 E SWANSON AVE
WASILLA AK
99654-7004
US

IV. Provider business mailing address

401 W INTERNATIONAL AIRPORT RD STE 17
ANCHORAGE AK
99518-1168
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-3275
  • Fax: 907-562-4503
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: