Provider Demographics
NPI:1285026419
Name:ALKIRA MARRIAGE AND FAMILY THERAPY PC
Entity Type:Organization
Organization Name:ALKIRA MARRIAGE AND FAMILY THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MA
Authorized Official - Phone:315-492-1390
Mailing Address - Street 1:6700 KIRKVILLE ROAD BUILDING B
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9373
Mailing Address - Country:US
Mailing Address - Phone:315-492-1390
Mailing Address - Fax:315-314-7726
Practice Address - Street 1:6700 KIRKVILLE ROAD BUILDING B
Practice Address - Street 2:SUITE 107
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9373
Practice Address - Country:US
Practice Address - Phone:315-492-1390
Practice Address - Fax:315-314-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386857217OtherNPPES
1679866982OtherNPPES
NY1750582771OtherNPPES
NY177835753OtherNPPES