Provider Demographics
NPI:1407140163
Name:MAT-SU VALLEY COUNSELING LLC
Entity Type:Organization
Organization Name:MAT-SU VALLEY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-357-8090
Mailing Address - Street 1:601 N BUNKER HILL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6790
Mailing Address - Country:US
Mailing Address - Phone:907-357-8090
Mailing Address - Fax:907-357-8092
Practice Address - Street 1:601 N BUNKER HILL ST
Practice Address - Street 2:SUITE D
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6790
Practice Address - Country:US
Practice Address - Phone:907-357-8090
Practice Address - Fax:907-357-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-30
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty