Provider Demographics
NPI:1184911851
Name:JETT MORGAN TREATMENT SERVICES, LLC
Entity type:Organization
Organization Name:JETT MORGAN TREATMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:AAS, CDC II, BHC II
Authorized Official - Phone:907-677-7709
Mailing Address - Street 1:400 W TUDOR RD
Mailing Address - Street 2:#A-400
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6614
Mailing Address - Country:US
Mailing Address - Phone:907-677-7709
Mailing Address - Fax:907-677-7095
Practice Address - Street 1:4701 BUSINESS PARK BLVD STE J20
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7170
Practice Address - Country:US
Practice Address - Phone:907-677-7709
Practice Address - Fax:907-677-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK954236101YA0400X, 251S00000X, 261QR0405X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1688197Medicaid