Provider Demographics
NPI:1003671348
Name:FREEDOM BEHAVIORAL HEALTH ALASKA LLC
Entity Type:Organization
Organization Name:FREEDOM BEHAVIORAL HEALTH ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING/ CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-475-7713
Mailing Address - Street 1:10928 EAGLE RIVER RD STE 254
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8080
Mailing Address - Country:US
Mailing Address - Phone:907-696-0221
Mailing Address - Fax:877-875-9556
Practice Address - Street 1:10928 EAGLE RIVER RD STE 254
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8080
Practice Address - Country:US
Practice Address - Phone:907-696-0221
Practice Address - Fax:877-875-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty