Provider Demographics
NPI:1124629985
Name:DAHMS, EMMA LOUISE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:DAHMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:LARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 S ALASKA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6372
Mailing Address - Country:US
Mailing Address - Phone:907-746-6019
Mailing Address - Fax:907-745-7565
Practice Address - Street 1:550 S ALASKA ST STE 202
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6372
Practice Address - Country:US
Practice Address - Phone:907-746-6019
Practice Address - Fax:907-745-7565
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1811042872Medicaid