NPIMap

Organization Active NPI

Mitkof Behavioral Health LLC

  • Clinical Social Worker
  • Petersburg, AK
National Provider Identifier
1164191698
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MITKOF BEHAVIORAL HEALTH LLC
Doing business as
Mitkof Behavioral Health
Practice address
403 Haugen Drive
#103
Petersburg, AK 99833-0771
Phone
(907) 650-0222
Fax
(907) 772-3710
NPI assigned
Sep 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Kara B Wesebaum, LCSWNPI 1114410073
Title
Owner
Phone
(907) 650-0222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

403 Haugen Drive
#103
Petersburg, AK 99833-0771

Mailing address

PO Box 771
Petersburg, AK 99833-0771
Phone (907) 650-0222

Other identifiers 1

IdentifierTypeStateIssuer
99833MedicaidAK

Other names 1

  • Mitkof Behavioral Health Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Petersburg

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1164191698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 771",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330771",
            "telephone_number": "907-650-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 HAUGEN DRIVE",
            "address_2": "#103",
            "city": "PETERSBURG",
            "state": "AK",
            "postal_code": "998330771",
            "telephone_number": "907-650-0222",
            "fax_number": "907-772-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITKOF BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-08",
        "last_updated": "2022-05-05",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "WESEBAUM",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-650-0222",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99833",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Petersburg",
            "affiliation": "N",
            "address_1": "403 Haugen Street",
            "address_2": "103",
            "city": "Petersburg",
            "state": "AK",
            "country_code": "US",
            "postal_code": "998330771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mitkof Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mitkof Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.