Provider Demographics
NPI:1396478103
Name:MELEAH, LAUREL SEUTATIA
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:SEUTATIA
Last Name:MELEAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 SAN ERNESTO AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2875
Mailing Address - Country:US
Mailing Address - Phone:907-729-5070
Mailing Address - Fax:
Practice Address - Street 1:SOUTHCENTRAL FOUNDATION 4501 DIPLOMACY DR.
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-729-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)