Provider Demographics
NPI:1003342288
Name:PACIFIC RIM COUNSELING, INC.
Entity Type:Organization
Organization Name:PACIFIC RIM COUNSELING, INC.
Other - Org Name:PACIFIC RIM COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-5252
Mailing Address - Street 1:1211 CUSHMAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4680
Mailing Address - Country:US
Mailing Address - Phone:907-452-5252
Mailing Address - Fax:907-452-6233
Practice Address - Street 1:1211 CUSHMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4680
Practice Address - Country:US
Practice Address - Phone:907-452-5252
Practice Address - Fax:907-452-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
AK906314261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health