MEDICARE: CITY OF KETCHIKAN-GATEWAY CENTER FOR HUMAN SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	AK
2	101YM0800X	Mental Health Counselor	AK
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	AK
4	101YP2500X	Professional Counselor	AK
5	103TC0700X	Clinical Psychologist	AK
6	1041C0700X	Clinical Social Worker	AK

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467445296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF KETCHIKAN-GATEWAY CENTER FOR HUMAN SERVICES

Provider Business Mailing Address
First Line	:	3050 5TH AVE
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5773
Country	:	US
Telephone Number	:	907-225-4135
Fax Number	:	907-247-4135

Provider Business Practice Location Address
First Line	:	3050 5TH AVE
Second Line	:
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5773
Country	:	US
Telephone Number	:	907-225-4135
Fax Number	:	907-247-4135

Authorized Official
Title or Position	:	CITY MANAGER
Name	:	MR. KARL AMYLON
Credential	:
Telephone Number	:	907-225-3111

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/11/2025

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