Provider Demographics
NPI:1124445762
Name:FAMILY CENTERED SERVICES OF ALASKA
Entity type:Organization
Organization Name:FAMILY CENTERED SERVICES OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-731-5160
Mailing Address - Street 1:1825 MARIKA RD
Mailing Address - Street 2:FAIRBANKS
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5521
Mailing Address - Country:US
Mailing Address - Phone:907-474-0890
Mailing Address - Fax:
Practice Address - Street 1:1825 MARIKA RD
Practice Address - Street 2:FAIRBANKS
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5521
Practice Address - Country:US
Practice Address - Phone:907-474-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH3237Medicaid