Provider Demographics
NPI:1457621914
Name:NEUROBEHAVIOR NORTH, INC.
Entity Type:Organization
Organization Name:NEUROBEHAVIOR NORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-5066
Mailing Address - Street 1:PO BOX 3034
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3034
Mailing Address - Country:US
Mailing Address - Phone:907-745-5066
Mailing Address - Fax:907-746-2851
Practice Address - Street 1:8201 N MICHAELSON ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8196
Practice Address - Country:US
Practice Address - Phone:907-745-5066
Practice Address - Fax:877-640-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK274751101Y00000X
AK121536103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty