Active NPI
Fairbanks Community Mental Health Services, LLC
- Professional Counselor
- Fairbanks, AK
National Provider Identifier
1396417325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Legal business name
- FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC
- Practice address
- 1521 Hilton Ave
Fairbanks, AK 99701-4015 - Phone
- (907) 563-1000
- NPI assigned
- Sep 28, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ashley Evenson
- Title
- Billing Manager
- Phone
- (907) 261-5317
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | Primary |
Addresses
Primary practice location
1521 Hilton Ave
Fairbanks, AK 99701-4015
Mailing address
4020 Folker St
Anchorage, AK 99508-5321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598661 | Medicaid | AK |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.akbh.org |
National Provider Directory
National Provider Directory- Tax ID family
- Fairbanks Community Mental Health Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Fairbanks, AK
- NPI 1790377588
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632787200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1632787200000",
"number": "1396417325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4020 FOLKER ST",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1521 HILTON AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997014015",
"telephone_number": "907-563-1000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-09-28",
"last_updated": "2021-09-28",
"certification_date": "2021-09-28",
"status": "A",
"authorized_official_last_name": "EVENSON",
"authorized_official_first_name": "ASHLEY",
"authorized_official_title_or_position": "BILLING MANAGER",
"authorized_official_telephone_number": "907-261-5317"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1598661",
"state": "AK"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.akbh.org",
"affiliation": "N",
"address_1": "1521 Hilton Ave",
"city": "Fairbanks",
"state": "AK",
"country_code": "US",
"postal_code": "997014015",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fairbanks, AK
- Fairbanks Community Care Coordination
- Fairbanks Community Imaging, LLC
- Fairbanks Community Mental Health Center
- Fairbanks Community Mental Health Services
- Fairbanks Community Mental Health Services, LLC
- Fairbanks Community Mental Health Services, LLC
- Fairbanks Counseling and Adoption
- Fairbanks Counseling Associates, LLC
- Fairbanks Dental Center LLC (Fairbanks Dental Center)
- Fairbanks Dental Specialists, LLC (Associates in Endodontics)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.