Provider Demographics
NPI:1457582645
Name:ST. MICHAEL, JAMES HENRY (DMIN)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HENRY
Last Name:ST. MICHAEL
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:BARRIS
Other - Last Name:MUSGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6499
Mailing Address - Fax:907-543-6159
Practice Address - Street 1:700 CHIEF HOFFMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-6499
Practice Address - Fax:907-543-6159
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid