Provider Demographics
NPI:1629013065
Name:GOOD SAMARITAN COUNSELING CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN COUNSELING CENTER
Other - Org Name:UHS GOOD SAMARITAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISSORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-264-3525
Mailing Address - Street 1:2530 DEBARR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2996
Mailing Address - Country:US
Mailing Address - Phone:907-264-3595
Mailing Address - Fax:907-264-3515
Practice Address - Street 1:4241 B ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5920
Practice Address - Country:US
Practice Address - Phone:907-565-4000
Practice Address - Fax:907-565-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103T00000X, 1041C0700X, 106H00000X, 2084P0800X, 2084P0804X
AK2817103T00000X
AK549652084P0800X
AK435363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH9217Medicaid
AKMH6578Medicaid