Provider Demographics
NPI:1891200911
Name:MONARCH PSYCHIATRY OF ALASKA LLC
Entity Type:Organization
Organization Name:MONARCH PSYCHIATRY OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-MANGROBANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-885-1089
Mailing Address - Street 1:101 W BENSON BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3936
Mailing Address - Country:US
Mailing Address - Phone:907-885-1089
Mailing Address - Fax:907-885-1059
Practice Address - Street 1:101 W BENSON BLVD STE 306
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3936
Practice Address - Country:US
Practice Address - Phone:907-885-1089
Practice Address - Fax:907-885-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK576103TC0700X
AK49652084P0800X
AK1062801261QM0850X, 261QM0855X
AK1364363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1679481Medicaid
AK615323OtherTRICARE HNFS GROUP NUMBER