Provider Demographics
NPI:1164163259
Name:ALASKA COUNSELOR LPC
Entity Type:Organization
Organization Name:ALASKA COUNSELOR LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-220-6090
Mailing Address - Street 1:410 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5357
Mailing Address - Country:US
Mailing Address - Phone:907-220-6090
Mailing Address - Fax:
Practice Address - Street 1:1200 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6136
Practice Address - Country:US
Practice Address - Phone:907-220-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health