Provider Demographics
NPI:1497943898
Name:METLAKATLA INDIAN COMMUNITY
Entity Type:Organization
Organization Name:METLAKATLA INDIAN COMMUNITY
Other - Org Name:METLAKATLA CHILDREN'S INTERVENTION PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-886-6914
Mailing Address - Street 1:100 UPPER MILTON AVE.
Mailing Address - Street 2:BOX 85
Mailing Address - City:METLAKATLA
Mailing Address - State:AK
Mailing Address - Zip Code:99926
Mailing Address - Country:US
Mailing Address - Phone:907-886-6914
Mailing Address - Fax:907-886-6913
Practice Address - Street 1:100 UPPER MILTON AVE
Practice Address - Street 2:
Practice Address - City:METLAKATLA
Practice Address - State:AK
Practice Address - Zip Code:99926
Practice Address - Country:US
Practice Address - Phone:907-886-6911
Practice Address - Fax:907-886-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health