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General NPI Number Information
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NPI Number | 1033308002
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Entity Type | Organization
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Legal Business Name | BERINGIA MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 225 WENDELL ST STE B
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City | FAIRBANKS
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State | AK
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Zip | 99701-4835
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Country | US
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Telephone | 907-455-4140
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Fax | 907-455-4119
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Provider Business Mailing Address
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Address Line | PO BOX 90349
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City | ANCHORAGE
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State | AK
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Zip | 99509-0349
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Country | US
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Telephone | 907-455-4140
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Fax | 907-455-4119
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOOKER T EVANS
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Credential | MD
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Telephone | 907-455-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4433
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License Number State | AK
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