| Neurobehavior North, Inc. | |
|
8201 N Michaelson St Palmer AK 99645-8196 | |
| (907) 745-5066 | |
| (907) 746-2851 |
| Full Name | Neurobehavior North, Inc. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 8201 N Michaelson St, Palmer, Alaska |
| Authorized Official Name and Position | Melinda Logan (OWNER/ OFFICE MANAGER) |
| Authorized Official Contact | 9077455066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurobehavior North, Inc. Po Box 3034 Palmer AK 99645-3034 Ph: (907) 745-5066 | Neurobehavior North, Inc. 8201 N Michaelson St Palmer AK 99645-8196 Ph: (907) 745-5066 |
| NPI Number | 1457621914 |
|---|---|
| Provider Enumeration Date | 12/30/2011 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Medicare PECOS PAC ID | 3870866080 |
|---|---|
| Medicare Enrollment ID | O20170911002151 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457621914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 274751 (Alaska) | Secondary |
| 103G00000X | Clinical Neuropsychologist | 121536 (Alaska) | Primary |
| Provider Name | Dustin M. Logan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851578512 PECOS PAC ID: 4284907213 Enrollment ID: I20170913001254 |
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