Provider Demographics
NPI:1003549742
Name:BELTZ, ALEX TRENTON (PSS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:TRENTON
Last Name:BELTZ
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871545
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1545
Mailing Address - Country:US
Mailing Address - Phone:907-376-4534
Mailing Address - Fax:907-376-2348
Practice Address - Street 1:26731 W POINT MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-8709
Practice Address - Country:US
Practice Address - Phone:907-376-4534
Practice Address - Fax:907-376-2348
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4870175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK4870OtherALASKA COMMISSION FOR BEHAVIORAL HEALTH CERTIFICATOIN