Provider Demographics
NPI:1588135776
Name:KENAI PENINSULA MENTAL HEALTH LLC
Entity type:Organization
Organization Name:KENAI PENINSULA MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:907-531-6047
Mailing Address - Street 1:PO BOX 2653
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2653
Mailing Address - Country:US
Mailing Address - Phone:907-531-3886
Mailing Address - Fax:907-531-3886
Practice Address - Street 1:133 SMITH WAY UNIT C
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8077
Practice Address - Country:US
Practice Address - Phone:907-531-6047
Practice Address - Fax:907-531-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty