Provider Demographics
NPI:1093460792
Name:ARCTIC OWL COUNSELING, LLC
Entity Type:Organization
Organization Name:ARCTIC OWL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CDC I
Authorized Official - Phone:907-223-4374
Mailing Address - Street 1:3505 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3404
Mailing Address - Country:US
Mailing Address - Phone:907-223-4374
Mailing Address - Fax:907-279-0069
Practice Address - Street 1:3505 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3404
Practice Address - Country:US
Practice Address - Phone:907-223-4374
Practice Address - Fax:907-279-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)