Provider Demographics
NPI:1437793635
Name:BEAGNYAM, JUSTINA BIH
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:BIH
Last Name:BEAGNYAM
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 1:500 E TUDOR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7377
Mailing Address - Country:US
Mailing Address - Phone:907-333-2468
Mailing Address - Fax:
Practice Address - Street 1:741 N BUNN ST APT 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1696
Practice Address - Country:US
Practice Address - Phone:907-333-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)