Healthcare Provider Details

I. General information

NPI: 1992836670
Provider Name (Legal Business Name): BEHAVIORAL HEALTH TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 E MAYFLOWER COURT
WASILLA AK
99654
US

IV. Provider business mailing address

5851 E MAYFLOWER COURT
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-4000
  • Fax: 907-373-1135
Mailing address:
  • Phone: 907-376-4000
  • Fax: 907-373-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
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:

# 1
IdentifierDA8235
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
IdentifierMH6030
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DESIRE SHEPLER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 907-746-6231