Fred Joe – Mental Health Counselor in Nightmute, AK

Key facts

NPI: 1891996807
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
Practice address: Nightmute Clinic
Nightmute, AK 99690
Phone: (907) 647-6312
Fax: (907) 647-6945
NPI assigned: May 29, 2007
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X			Yes

Addresses

Primary practice location

Nightmute Clinic
Nightmute, AK 99690

Mailing address

PO Box 528
Bethel, AK 99559-0528
Phone (907) 543-6100

Other identifiers

Identifier	Type	State	Issuer
DA4442	Medicaid	AK

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1891996807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 528",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995590528",
            "telephone_number": "907-543-6100",
            "fax_number": "907-543-6008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NIGHTMUTE CLINIC",
            "city": "NIGHTMUTE",
            "state": "AK",
            "postal_code": "99690",
            "telephone_number": "907-647-6312",
            "fax_number": "907-647-6945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOE",
        "first_name": "FRED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA4442",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nightmute, AK

All providers in Nightmute, AK · Mental Health Counselor in Alaska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.