Healthcare Provider Details

I. General information

NPI: 1326958349
Provider Name (Legal Business Name): FIREWEED MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 E BEAK CIR
WASILLA AK
99654-8409
US

IV. Provider business mailing address

5252 E BEAK CIR
WASILLA AK
99654-8409
US

V. Phone/Fax

Practice location:
  • Phone: 907-351-2163
  • Fax:
Mailing address:
  • Phone: 907-351-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT CHARLES BAY
Title or Position: MEMBER
Credential:
Phone: 907-351-2163