Provider Demographics
NPI:1922569540
Name:HYDABURG CITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:HYDABURG CITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:KIRCHNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-590-0931
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:HYDABURG
Mailing Address - State:AK
Mailing Address - Zip Code:99922-0109
Mailing Address - Country:US
Mailing Address - Phone:907-401-3359
Mailing Address - Fax:
Practice Address - Street 1:100 TOTEM PARK LANE
Practice Address - Street 2:
Practice Address - City:HYDABURG
Practice Address - State:AK
Practice Address - Zip Code:99922-9992
Practice Address - Country:US
Practice Address - Phone:907-401-3359
Practice Address - Fax:907-285-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK66OtherLICENSED PROFESSIONAL COUNSELOR