NPIMap

Organization Active NPI

Providence Health & Services Washington

Doing business as Providence Kodiak Island Counseling Center

  • Community/Behavioral Health Agency
  • Kodiak, AK
National Provider Identifier
1477563344
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
297340 Issued in AK
Legal business name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Doing business as
Providence Kodiak Island Counseling Center
Practice address
1818 E Rezanof Dr
Kodiak, AK 99615-6505
Phone
(907) 481-2400
Fax
(907) 481-2419
NPI assigned
Aug 9, 2006
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 297340 AK
Clinical Social Worker 1041C0700X 297340 AK
Psychiatry Physician 2084P0800X 297340 AK
Case Manager/Care Coordinator 171M00000X 297340 AK
Community/Behavioral Health Agency 251S00000X 297340 AK Primary

Addresses

Primary practice location

1818 E Rezanof Dr
Kodiak, AK 99615-6505

Mailing address

PO Box 31001-4162
Pasadena, CA 91110-4162
Phone (907) 486-9500

Other identifiers 1

IdentifierTypeStateIssuer
MH 2237 & DA2237MedicaidAK

Other names 1

  • PROVIDENCE KODIAK ISLAND COUNSELING CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326001151 AK Part B Supplier - Clinic/Group Practice 0547152217 Receives reassigned benefits from 14 practitioners
Practice locations: Kodiak, AK

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.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1477563344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4162",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104162",
            "telephone_number": "907-486-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 E REZANOF DR",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156505",
            "telephone_number": "907-481-2400",
            "fax_number": "907-481-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AK",
            "license": "297340",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "297340",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AK",
            "license": "297340",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AK",
            "license": "297340",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AK",
            "license": "297340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH 2237  & DA2237",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE KODIAK ISLAND COUNSELING CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE KODIAK ISLAND COUNSELING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.