Provider Demographics
NPI:1497105126
Name:URSERY, PRINCILLA PATRICE (LPC)
Entity Type:Individual
Prefix:
First Name:PRINCILLA
Middle Name:PATRICE
Last Name:URSERY
Suffix:
Gender:F
Credentials:LPC
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 472
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-0472
Mailing Address - Country:US
Mailing Address - Phone:907-987-6052
Mailing Address - Fax:866-898-9031
Practice Address - Street 1:3590 HOLDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4950
Practice Address - Country:US
Practice Address - Phone:907-456-6445
Practice Address - Fax:866-898-9031
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172683101YM0800X
MI6401017280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health