Provider Demographics
NPI:1629898317
Name:ALASKA TELEHEALTH THERAPY, LLC
Entity type:Organization
Organization Name:ALASKA TELEHEALTH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUZICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:907-252-6076
Mailing Address - Street 1:PO BOX 8291
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-8291
Mailing Address - Country:US
Mailing Address - Phone:907-252-6076
Mailing Address - Fax:
Practice Address - Street 1:51137 NANOOK CIR
Practice Address - Street 2:
Practice Address - City:NIKISKI
Practice Address - State:AK
Practice Address - Zip Code:99611-9318
Practice Address - Country:US
Practice Address - Phone:907-252-6076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty