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General NPI Number Information
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NPI Number | 1629504634
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Entity Type | Organization
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Legal Business Name | KENAI RIVER COUNSELING
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 44539 STERLING HWY #213
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City | SOLDOTNA
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State | AK
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Zip | 99669-7920
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Country | US
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Telephone | 602-376-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 44539 STERLING HWY #213
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City | SOLDOTNA
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State | AK
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Zip | 99669-7920
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Country | US
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Telephone | 602-376-3146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA M BARLOW
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Credential | MA, LPC
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Telephone | 602-376-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 115272
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License Number State | AK
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