Provider Demographics
NPI:1801276605
Name:KRISTIE A ALLEVA
Entity type:Organization
Organization Name:KRISTIE A ALLEVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-315-5098
Mailing Address - Street 1:6966 N WASILLA FISHHOOK RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-0443
Mailing Address - Country:US
Mailing Address - Phone:907-315-5098
Mailing Address - Fax:
Practice Address - Street 1:491 N KNIK ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7049
Practice Address - Country:US
Practice Address - Phone:907-315-5098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK927251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health