Provider Demographics
NPI:1720318736
Name:GOOD SIDE OUT, LLC
Entity type:Organization
Organization Name:GOOD SIDE OUT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MS/MA, LPC
Authorized Official - Phone:907-317-1859
Mailing Address - Street 1:4432 AMES AVE., ANCHORAGE AK 99508
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-317-1859
Mailing Address - Fax:907-802-6121
Practice Address - Street 1:405 E. FIREWEED LANE, ANCORAGE AK 99503
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-317-1859
Practice Address - Fax:907-802-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AK596261QM0850X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty