Provider Demographics
NPI:1174354922
Name:REWILDING BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:REWILDING BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:STROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-312-5822
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:TALKEETNA
Mailing Address - State:AK
Mailing Address - Zip Code:99676-1187
Mailing Address - Country:US
Mailing Address - Phone:907-312-5822
Mailing Address - Fax:907-313-8073
Practice Address - Street 1:16255 E POW WOW TRAIL
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676-1187
Practice Address - Country:US
Practice Address - Phone:907-312-5822
Practice Address - Fax:907-313-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty