Provider Demographics
NPI:1457491409
Name:KENAITZE INDIAN TRIBE
Entity Type:Organization
Organization Name:KENAITZE INDIAN TRIBE
Other - Org Name:NAKENU FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN SRVS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YEOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-283-6693
Mailing Address - Street 1:110 N. WILLOW
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-283-6693
Mailing Address - Fax:907-283-7088
Practice Address - Street 1:110 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7701
Practice Address - Country:US
Practice Address - Phone:907-283-6693
Practice Address - Fax:907-283-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103TB0200X, 1041C0700X
AK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH2436Medicaid
AKDA5032Medicaid