Provider Demographics
NPI:1275897548
Name:KETZLER, STEVEN (CAMP COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:KETZLER
Suffix:
Gender:M
Credentials:CAMP COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:NENANA
Mailing Address - State:AK
Mailing Address - Zip Code:99760-0145
Mailing Address - Country:US
Mailing Address - Phone:907-590-0280
Mailing Address - Fax:
Practice Address - Street 1:122 1ST AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4803
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility