Provider Demographics
NPI:1285298075
Name:GREIST, MILDRED SARAH
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:SARAH
Last Name:GREIST
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MILDRED
Other - Middle Name:SARAH
Other - Last Name:GREIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER STREET
Practice Address - Street 2:
Practice Address - City:SELAWIK
Practice Address - State:AK
Practice Address - Zip Code:99770
Practice Address - Country:US
Practice Address - Phone:907-484-2199
Practice Address - Fax:907-484-2119
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)