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General NPI Number Information
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NPI Number | 1215314307
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Entity Type | Organization
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Legal Business Name | UNCOMMON OPPORTUNITIES INC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 250 CUSHMAN ST STE 2G
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City | FAIRBANKS
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State | AK
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Zip | 99701-4665
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Country | US
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Telephone | 907-388-8963
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Fax | 907-374-1013
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Provider Business Mailing Address
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Address Line | PO BOX 71182
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City | FAIRBANKS
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State | AK
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Zip | 99707-1182
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Country | US
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Telephone | 907-388-8963
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Fax | 907-374-1013
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE A MOEN
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Credential | LPC
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Telephone | 907-388-8963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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