NPIMap

Organization Active NPI

Freedom Behavioral Health Alaska LLC

  • Psychiatry Physician
  • Eagle River, AK
National Provider Identifier
1003671348
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
FREEDOM BEHAVIORAL HEALTH ALASKA LLC
Practice address
10928 Eagle River Rd Ste 254
Eagle River, AK 99577-8080
Phone
(907) 696-0221
Fax
(877) 875-9556
NPI assigned
Feb 15, 2024
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kerry Brooke Clemetson
Title
Director of Billing
Phone
(913) 405-9458

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

10928 Eagle River Rd Ste 254
Eagle River, AK 99577-8080

Mailing address

10928 Eagle River Rd Ste 254
Eagle River, AK 99577-8080
Phone (907) 696-0221

Other practice location 1

3540 International St
Fairbanks, AK 99701-7382
Phone (907) 328-0581

Other practice location 2

4015 Lake Otis Pkwy Ste 101
Anchorage, AK 99508-5235
Phone (905) 865-7773

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240415002290 AK Part B Supplier - Clinic/Group Practice 4880033513 Receives reassigned benefits from 8 practitioners
Practice locations: Eagle River, AK; Fairbanks, AK

National Provider Directory

National Provider Directory

Locations

10928 Eagle River Rd
Ste 254
Eagle River, AK 99577
Phone (907) 696-0221

3540 International St
Fairbanks, AK 99701
Phone (907) 328-0581

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1003671348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10928 EAGLE RIVER RD STE 254",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778080",
            "telephone_number": "907-696-0221",
            "fax_number": "877-875-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10928 EAGLE RIVER RD STE 254",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778080",
            "telephone_number": "907-696-0221",
            "fax_number": "877-875-9556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3540 International St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997017382",
            "country_code": "US",
            "telephone_number": "907-328-0581",
            "fax_number": "866-738-9486",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4015 Lake Otis Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995085235",
            "country_code": "US",
            "telephone_number": "905-865-7773",
            "fax_number": "866-712-8019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FREEDOM BEHAVIORAL HEALTH ALASKA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "CLEMETSON",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "BROOKE",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "913-405-9458"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.