Provider Demographics
NPI:1932832086
Name:THE MENTAL HEALTH CO-OP LLC
Entity Type:Organization
Organization Name:THE MENTAL HEALTH CO-OP LLC
Other - Org Name:THE MENTAL HEALTH CO-OP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-390-0542
Mailing Address - Street 1:PO BOX 3731
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3731
Mailing Address - Country:US
Mailing Address - Phone:907-390-0542
Mailing Address - Fax:
Practice Address - Street 1:1901 N HEMMER RD STE 209
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9690
Practice Address - Country:US
Practice Address - Phone:907-390-0542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty