Healthcare Provider Details

I. General information

NPI: 1750794467
Provider Name (Legal Business Name): ALEXA SEPNAFSKI CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E DANNA AVE
WASILLA AK
99654-6422
US

IV. Provider business mailing address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-7519
  • Fax: 907-357-7569
Mailing address:
  • Phone: 907-474-0890
  • Fax: 907-474-3621

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 Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierMH3237
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: