Healthcare Provider Details

I. General information

NPI: 1063335818
Provider Name (Legal Business Name): MIKAEL PORCELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 N KNIK ST
WASILLA AK
99654-7049
US

IV. Provider business mailing address

2838 N WOODFIELD DR
WASILLA AK
99654-2819
US

V. Phone/Fax

Practice location:
  • Phone: 907-671-2725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: