Provider Demographics
NPI:1942699624
Name:ALASKA PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ALASKA PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:907-334-1000
Mailing Address - Street 1:741 SESAME ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6657
Mailing Address - Country:US
Mailing Address - Phone:907-334-1000
Mailing Address - Fax:907-334-8080
Practice Address - Street 1:741 SESAME ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6657
Practice Address - Country:US
Practice Address - Phone:907-334-1000
Practice Address - Fax:907-334-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK581103TC0700X
AK574103TC0700X
AK12221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty