Provider Demographics
NPI:1871147520
Name:ELKINS, MARY (LPC, CDC I)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LPC, CDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90574
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0574
Mailing Address - Country:US
Mailing Address - Phone:907-331-0576
Mailing Address - Fax:800-511-7484
Practice Address - Street 1:341 W TUDOR ROAD, SUITE 209
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6648
Practice Address - Country:US
Practice Address - Phone:907-331-0576
Practice Address - Fax:800-511-7484
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4679101YA0400X
WAMX61300797101YM0800X
AK182614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1728127Medicaid