Provider Demographics
NPI:1356551063
Name:TOK AREA MENTAL HEALTH COUNCIL, INC.
Entity type:Organization
Organization Name:TOK AREA MENTAL HEALTH COUNCIL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ORA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC,DI
Authorized Official - Phone:907-883-5855
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:W.1ST ST SUITE 8
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0398
Mailing Address - Country:US
Mailing Address - Phone:907-883-5106
Mailing Address - Fax:907-883-5108
Practice Address - Street 1:W.1ST STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0398
Practice Address - Country:US
Practice Address - Phone:907-883-5106
Practice Address - Fax:907-883-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK183290261QM0850X, 261QM0855X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH0285Medicaid
AKTAM84686OtherSTATE OF AK VENDOR ID #
AK183290OtherALASKA BUSINESS LICENSE #
AK20456DOtherDCCED CBPL AK ENTITY #
AK20456DOtherDCCED CBPL AK ENTITY #