Organization
GREATLAND MENTAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA M RONCO (BILLING MANAGER)
(907) 632-7577
Entity
Organization
Contact information
Practice address
1407 W 31ST AVE, STE 201, ANCHORAGE, AK 99503-3678
(907) 929-4009
(907) 929-4902
Mailing address
PO BOX 111810, ANCHORAGE, AK 99511-1810
(907) 929-4009
(907) 929-4902
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH3538
—
AK
Enumeration date
07/25/2007
Last updated
07/25/2007
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