Provider Demographics
NPI:1043358062
Name:UNIVERSITY OF ALASKA FAIRBANKS CENTER FOR HEALTH & COUNSELING
Entity Type:Organization
Organization Name:UNIVERSITY OF ALASKA FAIRBANKS CENTER FOR HEALTH & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLERATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-474-7043
Mailing Address - Street 1:PO BOX 755580
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99775-5580
Mailing Address - Country:US
Mailing Address - Phone:907-474-7043
Mailing Address - Fax:907-474-5777
Practice Address - Street 1:612 N. CHANDALAR DR.
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99775-5580
Practice Address - Country:US
Practice Address - Phone:907-474-7043
Practice Address - Fax:907-474-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health