Provider Demographics
NPI:1588263172
Name:LESTENKOF, MAYROSE SYNA
Entity type:Individual
Prefix:
First Name:MAYROSE
Middle Name:SYNA
Last Name:LESTENKOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 MULDOON RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-274-8281
Mailing Address - Fax:
Practice Address - Street 1:1251 MULDOON RD
Practice Address - Street 2:SUITE 116
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504
Practice Address - Country:US
Practice Address - Phone:907-274-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health