Gwendolynn Stacy Chickalusion, COUNSELOR TECHNICIAN

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

5068 Issued in AK

Practice address

1230 Ocean Dr Ste 1
Homer, AK 99603-7911

Phone

(907) 235-8319

Fax

(907) 235-8099

NPI assigned

Oct 13, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Inlet Council on Alcohol and Drug Abuse

  • Community/Behavioral Health Agency
  • Homer, AK
  • NPI 1740838085
  NPD

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1235911397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2352",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996032352",
            "telephone_number": "907-235-8001",
            "fax_number": "907-235-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 OCEAN DR STE 1",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037911",
            "telephone_number": "907-235-8319",
            "fax_number": "907-235-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHICKALUSION",
        "first_name": "GWENDOLYNN",
        "middle_name": "STACY",
        "credential": "COUNSELOR TECHNICIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AK",
            "license": "5068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Changing Tides Therapy Services, Inc
• Samuel Chazin
• Amanda Jo Cherok, PT, DPT
• Jay C Cherok, DPT
• Melody Chesley, L.AC.
• Chirotherm Inc
• Nathan Chorman
• Amy Louise Christiansen, R.N.
• Cirque Therapy, LLC
• City of Homer

• Addiction (Substance Use Disorder) Counselor in Homer, AK
• Providers in Homer, AK by specialty
• Addiction (Substance Use Disorder) Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; 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.