Provider Demographics
NPI:1912695479
Name:ARDENT GRACE COUNSELING AND TELETHERAPY, LLC
Entity Type:Organization
Organization Name:ARDENT GRACE COUNSELING AND TELETHERAPY, LLC
Other - Org Name:ARDENT GRACE COUNSELING AND TELETHERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:254-271-0055
Mailing Address - Street 1:8165 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9167
Mailing Address - Country:US
Mailing Address - Phone:254-747-1297
Mailing Address - Fax:254-477-7023
Practice Address - Street 1:441 W 5TH AVE STE 405
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2340
Practice Address - Country:US
Practice Address - Phone:254-747-1297
Practice Address - Fax:254-477-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health