NPIMap

Organization Active NPI

Providence Kodiak Island Counseling Center

  • Community/Behavioral Health Agency
  • Kodiak, AK
National Provider Identifier
1376141929
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PROVIDENCE KODIAK ISLAND COUNSELING CENTER
Practice address
717 E Rezanof Dr
Kodiak, AK 99615-6416
Phone
(907) 481-2400
Fax
(907) 481-2419
NPI assigned
Oct 15, 2020
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

717 E Rezanof Dr
Kodiak, AK 99615-6416

Mailing address

PO Box 3290
Portland, OR 97208-3290
Phone (907) 481-2000

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Srvcs Wa2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1376141929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3290",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083290",
            "telephone_number": "907-481-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156416",
            "telephone_number": "907-481-2400",
            "fax_number": "907-481-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE KODIAK ISLAND COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kodiak, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.