| Desert Spring Behavioral Health, Llc | |
|
290 N Willow St Wasilla AK 99654-7042 | |
| (907) 203-1590 | |
| Not Available |
| Full Name | Desert Spring Behavioral Health, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 290 N Willow St, Wasilla, Alaska |
| Authorized Official Name and Position | Lisa Marie Mrzena (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9073016668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Spring Behavioral Health, Llc Po Box 876023 Wasilla AK 99687-6023 Ph: (907) 203-1590 | Desert Spring Behavioral Health, Llc 290 N Willow St Wasilla AK 99654-7042 Ph: (907) 203-1590 |
| NPI Number | 1962803270 |
|---|---|
| Provider Enumeration Date | 09/07/2014 |
| Last Update Date | 06/16/2021 |
| Certification Date | 06/16/2021 |
| Medicare PECOS PAC ID | 1658697925 |
|---|---|
| Medicare Enrollment ID | O20150304000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962803270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6593775-4405 (Utah) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Lisa Marie Mrzena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053645770 PECOS PAC ID: 6901029560 Enrollment ID: I20140529000389 |
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