Provider Demographics
NPI:1104654722
Name:HEALING ROCK COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:HEALING ROCK COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-354-0439
Mailing Address - Street 1:23450 GLACIER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9617
Mailing Address - Country:US
Mailing Address - Phone:907-354-0439
Mailing Address - Fax:907-689-7625
Practice Address - Street 1:11517 OLD GLENN HWY STE 204
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7312
Practice Address - Country:US
Practice Address - Phone:907-354-0439
Practice Address - Fax:907-689-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1871780452Medicaid
AK1275165763Medicaid