Provider Demographics
NPI:1518346840
Name:ALYESKA COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:ALYESKA COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMITO
Authorized Official - Middle Name:JO
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:907-782-4553
Mailing Address - Street 1:PO BOX 230795
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-0795
Mailing Address - Country:US
Mailing Address - Phone:907-782-4553
Mailing Address - Fax:
Practice Address - Street 1:701 W 41ST AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6604
Practice Address - Country:US
Practice Address - Phone:907-782-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK926414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty