Provider Demographics
NPI:1831254283
Name:HOMER PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:HOMER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON-GAMACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-4123
Mailing Address - Street 1:323 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7418
Mailing Address - Country:US
Mailing Address - Phone:907-235-4123
Mailing Address - Fax:907-235-4771
Practice Address - Street 1:323 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7418
Practice Address - Country:US
Practice Address - Phone:907-235-4123
Practice Address - Fax:907-235-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK308943261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)