Provider Demographics
NPI:1023128162
Name:PSYCHIATRIC & COUNSELING SERVICES
Entity type:Organization
Organization Name:PSYCHIATRIC & COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MN,ANP
Authorized Official - Phone:907-376-9369
Mailing Address - Street 1:5431 MAYFLOWER LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7817
Mailing Address - Country:US
Mailing Address - Phone:907-376-9369
Mailing Address - Fax:907-376-9363
Practice Address - Street 1:5431 MAYFLOWER LN
Practice Address - Street 2:SUITE 2
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7817
Practice Address - Country:US
Practice Address - Phone:907-376-9369
Practice Address - Fax:907-376-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK752103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP07521Medicaid
AKNP07521Medicaid