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General NPI Number Information
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NPI Number | 1508121096
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Entity Type | Organization
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Legal Business Name | BOREALIS BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 634 S BAILEY ST SUITE 207
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City | PALMER
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State | AK
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Zip | 99645-6330
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Country | US
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Telephone | 907-745-7080
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Fax | 907-745-6263
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Provider Business Mailing Address
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Address Line | 634 S BAILEY ST SUITE 207
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City | PALMER
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State | AK
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Zip | 99645-6330
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Country | US
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Telephone | 907-745-7080
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Fax | 907-745-6263
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Authorized Official
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Title or Position | MEMBER
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Name | JANA TERESE MINER-COLLINS
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Credential | LMFT
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Telephone | 907-745-7080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 86
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 241
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 77
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License Number State | AK
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