FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC (NPI# 1972987998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972987998 |
| Entity Type | Organization |
| Organization Name | FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC |
| Practice Address |
3830 S Cushman St Fairbanks AK 99701-7530 |
| Mailing Address |
4020 Folker St Anchorage AK 99508-5321 |
| Practice Telephone | 9073711300 |
| Practice Fax Number | 9077708917 |
| Mailing Telephone | 9075611000 |
| Mailing Fax Number | 9077708917 |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |
| Authorized Official Name | AMY MORROW (BILLING MANAGER) |
| Authorized Official Telephone | 9077622820 |
| Is Organization Subpart | Y |
| Parent Organization Name | ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers | ||
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MEDICARE | K165350 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023445871 | Fairbanks Community Mental Health Services, LLC | Clinic/Center | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2013-10-10 |
| Street Address |
3830 S CUSHMAN ST |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701-7530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235265430 | Bonnie Abbey | Counselor | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2007-02-24 |
| 1902252570 | Laquawna M Baker | Social Worker | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2016-05-12 |
| 1710332713 | Akeela Inc | Community/Behavioral Health | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2016-04-27 |
| 1043679889 | Cara Hollingsworth | Registered Nurse | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2016-02-22 |
| 1700250917 | Danielle Denise Nelson | Counselor | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2015-11-25 |
| 1265800379 | Michaela Cameron | Counselor | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2015-09-04 |
| 1093183220 | Susanne Jenemann | Marriage & Family Therapist | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2015-09-03 |
| 1689071441 | Catherine Jibben | Registered Nurse | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2014-11-21 |
| 1396141834 | Jessica Mckay | Social Worker | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2014-11-11 |
| 1780089508 | Jennifer Brinkman | Case Manager/Care Coordinator | 3830 S Cushman St, Fairbanks, AK 99701-7530 | 2014-10-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659984987 | Resource Center for Parents & Children, Inc. | Social Worker | 726 26th Ave, Suite #2, Fairbanks, AK 99701 | 2020-08-26 |
| 1134738982 | Aaron Paul Sarauer | Behavior Technician | 3121 Lathrop St., Fairbanks, AK 99701 | 2020-07-28 |
| 1437715505 | Fabienne Rose Marie Siddall | Case Manager/Care Coordinator | 122 1st Avenue, Fairbanks, AK 99701 | 2019-05-14 |
| 1902461957 | Jacqueline Marie Rahm | Counselor | Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 | 2019-05-06 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1922519305 | Sarishma Sangeeta Lal | Registered Nurse | 815 2nd Ave Ste 122, Fairbanks, AK 99701 | 2017-10-12 |
| 1245690569 | Christine L Simko | Naturopath | 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 | 2016-02-29 |
| 1932581600 | Jennifer Davis | Registered Nurse | 1025 West Barnette St., Fairbanks, AK 99701 | 2015-06-18 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1578957460 | Mara Justine Becker | Physician Assistant | 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 | 2015-03-27 |
| Find all providers in zip 99701 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.