MEDICARE: ALETA S. VAIL LMFT

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	106H00000X	Marriage & Family Therapist	204	AK

General Provider Information

NPI Number	:	1891901203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETA S. VAIL LMFT

Provider Business Mailing Address
First Line	:	2550 DENALI ST
Second Line	:	SUITE 1608
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-2736
Country	:	US
Telephone Number	:	907-336-4357
Fax Number	:	907-278-3171

Provider Business Practice Location Address
First Line	:	2550 DENALI ST
Second Line	:	SUITE 1608
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-2736
Country	:	US
Telephone Number	:	907-336-4357
Fax Number	:	907-278-3171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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