Provider Demographics
NPI:1417264805
Name:HARREL, DARA
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:HARREL
Suffix:
Gender:F
Credentials:
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 875324
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-5324
Mailing Address - Country:US
Mailing Address - Phone:907-313-7537
Mailing Address - Fax:800-524-9541
Practice Address - Street 1:500 N MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-313-8049
Practice Address - Fax:800-524-9541
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional