Provider Demographics
NPI:1245919794
Name:HOPE HOLDERS KETCHIKAN
Entity type:Organization
Organization Name:HOPE HOLDERS KETCHIKAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-821-4674
Mailing Address - Street 1:3175 JACKSON HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5782
Mailing Address - Country:US
Mailing Address - Phone:907-617-1378
Mailing Address - Fax:
Practice Address - Street 1:3175 JACKSON HEIGHTS ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5782
Practice Address - Country:US
Practice Address - Phone:907-617-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty