Organization
KATIE'S WAY FAIRBANKS, LLC
Active
Organization
KATIE'S WAY FAIRBANKS, LLC
Active
Other names
KATIES WAY
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY RAE JOHNSON (CREDENTIALING DIRECTOR)
(785) 320-6616
Entity
Organization
Contact information
Practice address
1275 SADLER WAY STE 104, FAIRBANKS, AK 99701-3175
(907) 921-5511
(907) 921-3574
Mailing address
1275 SADLER WAY STE 102, FAIRBANKS, AK 99701-3175
(907) 921-5511
(907) 921-3574
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
202D00000X
Integrative Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
2084P0015X
Psychosomatic Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/10/2023
Last updated
11/20/2024
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