Provider Demographics
NPI:1669788212
Name:KENNITH E MCCARTY
Entity type:Organization
Organization Name:KENNITH E MCCARTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-487-2223
Mailing Address - Street 1:1423 SIMEONOFF STREET
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-9961
Mailing Address - Country:US
Mailing Address - Phone:907-487-2223
Mailing Address - Fax:907-487-2229
Practice Address - Street 1:2975 MILL BAY RD.
Practice Address - Street 2:SUITE B
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-9961
Practice Address - Country:US
Practice Address - Phone:907-487-2223
Practice Address - Fax:907-487-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty