Provider Demographics
NPI:1295786119
Name:UNRUH, ERIC M (LCSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:UNRUH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 PARK PLACE STREET
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577
Mailing Address - Country:US
Mailing Address - Phone:907-622-1002
Mailing Address - Fax:907-622-8808
Practice Address - Street 1:17105 PARK PLACE ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7821
Practice Address - Country:US
Practice Address - Phone:907-622-1002
Practice Address - Fax:907-622-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMH3681Medicaid