Provider Demographics
NPI:1649571142
Name:SEEGANNA PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:SEEGANNA PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEEGANNA
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-929-5280
Mailing Address - Street 1:1407 W 31ST AVE
Mailing Address - Street 2:STE. 201D
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3678
Mailing Address - Country:US
Mailing Address - Phone:907-929-5280
Mailing Address - Fax:907-929-5290
Practice Address - Street 1:1407 W 31ST AVE
Practice Address - Street 2:STE. 201D
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3678
Practice Address - Country:US
Practice Address - Phone:907-929-5280
Practice Address - Fax:907-929-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK633363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty