Organization
MITKOF BEHAVIORAL HEALTH LLC
Active
Other names
Mitkof Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
KARA B WESEBAUM LCSW (OWNER)
(907) 650-0222
Entity
Organization
Contact information
Practice address
403 HAUGEN DRIVE, #103, PETERSBURG, AK 99833-0771
(907) 650-0222
(907) 772-3710
Mailing address
PO BOX 771, PETERSBURG, AK 99833-0771
(907) 650-0222
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99833
—
AK
Enumeration date
09/08/2021
Last updated
05/05/2022
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