Brain Boma
Individual provider Active NPI Counselor · Bethel, AK
NPI 1215322136 · NPPES record last updated Mar 30, 2015
Key facts
- NPI
- 1215322136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 835 Chief Eddie Hoffman Highway
Bethel, AK 99559 - Phone
- (907) 543-6552
- Fax
- (907) 543-6535
- NPI assigned
- Mar 30, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
835 Chief Eddie Hoffman Highway
Bethel, AK 99559
Mailing address
PO Box 528
Attn:BH Morgan House Program
Bethel, AK 99559-0528
Phone (907) 543-6552
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020986 | Medicaid | AK |
Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.