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General NPI Number Information
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NPI Number | 1073766317
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Entity Type | Organization
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Legal Business Name | KIC/THC BEHAVIORAL HEALTH DEPARTMENT
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 2960 TONGASS AVE FL 1
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City | KETCHIKAN
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State | AK
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Zip | 99901-5742
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Country | US
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Telephone | 907-228-4917
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Fax | 907-228-4920
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Provider Business Mailing Address
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Address Line | 2960 TONGASS AVE FL 1
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City | KETCHIKAN
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State | AK
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Zip | 99901-5742
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Country | US
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Telephone | 907-228-4917
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Fax | 907-228-4920
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. DEBBIE PATTON
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Credential | MPA
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Telephone | 907-228-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | AK
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