Provider Demographics
NPI:1194859850
Name:CENTER FOR PSYCHOSOCIAL DEVELOPMENT
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOSOCIAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:907-272-8270
Mailing Address - Street 1:2702 GAMBELL ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2835
Mailing Address - Country:US
Mailing Address - Phone:907-272-8270
Mailing Address - Fax:907-274-4802
Practice Address - Street 1:2702 GAMBELL ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2835
Practice Address - Country:US
Practice Address - Phone:907-272-8270
Practice Address - Fax:907-274-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK51575D251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7089Medicaid