Provider Demographics
NPI:1033308002
Name:BERINGIA MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:BERINGIA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOOKER
Authorized Official - Middle Name:T
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-455-4140
Mailing Address - Street 1:PO BOX 90349
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0349
Mailing Address - Country:US
Mailing Address - Phone:907-455-4140
Mailing Address - Fax:907-455-4119
Practice Address - Street 1:225 WENDELL ST
Practice Address - Street 2:STE B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4835
Practice Address - Country:US
Practice Address - Phone:907-455-4140
Practice Address - Fax:907-455-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK44332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING73883Medicare UPIN