Healthcare Provider Details

I. General information

NPI: 1750991956
Provider Name (Legal Business Name): ALASKA TELETHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 N 195TH ST
SHORELINE WA
98133-3703
US

IV. Provider business mailing address

1909 N 195TH ST
SHORELINE WA
98133-3703
US

V. Phone/Fax

Practice location:
  • Phone: 907-444-9134
  • Fax: 800-480-3188
Mailing address:
  • Phone: 907-229-8629
  • Fax: 800-480-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN M MAGONE
Title or Position: OWNER / PROVIDER
Credential: MA LPC-S, LMHC
Phone: 907-444-9134