Susie Katherine Mitkov

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1521 S Cushman St
Fairbanks, AK 99701-6203

Phone

(907) 452-8251

Fax

(907) 459-3842

NPI assigned

Jul 8, 2022

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

Other identifiers 1

Other names 1

• Susie Katherine Burris Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Tanana Chiefs Conference

  • Community/Behavioral Health Agency
  • Fairbanks, AK
  • NPI 1841835980
  NPD

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1669105375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 S CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016203",
            "telephone_number": "907-452-8251",
            "fax_number": "907-459-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 S CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016203",
            "telephone_number": "907-452-8251",
            "fax_number": "907-459-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITKOV",
        "first_name": "SUSIE",
        "middle_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "5191621",
            "state": "AK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Susie.Mitkov@tananachiefs.org",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1521 S Cushman St",
            "city": "Fairbanks",
            "state": "AK",
            "country_code": "US",
            "postal_code": "997016203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUSIE",
            "last_name": "BURRIS",
            "middle_name": "KATHERINE",
            "credential": "N/A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gwendolyn Elaine Mitchell
• Kiella-Rose Marie Mitchell
• Marquise Mitchell
• Shantavia Mitchell
• Stephen Waller Mitchell, M.A.
• Alexis C Mobius, BA
• Inga Moe
• Larry Moen, LPC
• Gary Ian Molk, D.O.
• Molly Leahy, LPC, PC

• Addiction (Substance Use Disorder) Counselor in Fairbanks, AK
• Providers in Fairbanks, 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 Jul 8, 2022; 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.