MEDICARE: HEALING ROCK COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104654722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING ROCK COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	23450 GLACIER VIEW DR
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-9617
Country	:	US
Telephone Number	:	907-354-0439
Fax Number	:	907-689-7625

Provider Business Practice Location Address
First Line	:	11517 OLD GLENN HWY STE 204
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7312
Country	:	US
Telephone Number	:	907-354-0439
Fax Number	:	907-689-7625

Authorized Official
Title or Position	:	ORGANIZATION OFFICIAL
Name	:	CATHY JEAN KING
Credential	:	PHD
Telephone Number	:	907-354-0439

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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