Provider Demographics
NPI:1336847987
Name:VISOCSKY, BRIAN KEITH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:VISOCSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:907-442-7749
Practice Address - Street 1:733 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:907-442-7749
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health