Providence Health & Services Washington
Organization Active NPI Community/Behavioral Health Agency · Kodiak, AK
NPI 1477563344 · NPPES record last updated Jun 30, 2026
Key facts
- NPI
- 1477563344
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 297340 (AK)
- Legal business name
- PROVIDENCE HEALTH & SERVICES WASHINGTON
- Practice address
- 1818 E Rezanof Dr
Kodiak, AK 99615-6505 - Phone
- (907) 481-2400
- Fax
- (907) 481-2419
- NPI assigned
- Aug 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Donald Wayne Anderson Jr.
- Title
- Assistant Secretary of Enrollments
- Phone
- (425) 358-9786
Corporate family (same tax ID) 1
Practitioners 15
-
Debbie-Lynn H Gibson, LMSW
-
Rebekah R Jones, LPC
-
Amber Wellner, ANP
-
James R Atkinson, LMFT
-
Belinda K Chambers, MS, RD, LCSW
-
Janna Harvey, LPC
-
Tahnee R King, LCSW
-
Edmore Mangena, LPC
-
James M Price, LPC, CDC II, MAC
-
Ronnie Boy Burns, DO
-
Glyn T. Deputy, LPC
-
Zaria R Gentle, LMSW
-
Matthew J Wadsworth, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040326001151 | AK | Part B Supplier - Clinic/Group Practice | 0547152217 |
Receives reassigned benefits from 14 practitioners Practice locations: Kodiak, AK |
National Provider Directory
- Tax ID family
- Providence Health Srvcs Wa
Locations
717 E Rezanof Dr
Kodiak, AK 99615
Phone (907) 481-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | 297340 | AK | |
| Clinical Social Worker |
1041C0700X | 297340 | AK | |
| Case Manager/Care Coordinator |
171M00000X | 297340 | AK | |
| Psychiatry Physician |
2084P0800X | 297340 | AK | |
| Community/Behavioral Health Agency | 251S00000X | 297340 | AK | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MH 2237 & DA2237 | Medicaid | AK |
Other names
- PROVIDENCE KODIAK ISLAND COUNSELING CENTER
Other providers in Kodiak, AK
- Providence Health & Services - Washington
- Providence Health & Services - Washington
- Providence Health & Services -Washington
- Providence Health & Services Washington
- Providence Health & Services Washington
- Providence Health & Services Washington
- Providence Health & Services Washington
- Providence Health & Services Washington
- Providence Kodiak Island Counseling Center
- Providence Kodiak Island Counseling Center
All providers in Kodiak, AK · Community/Behavioral Health Agency in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.