Basic Information
| Provider Information | |||||||||
| NPI: | 1326418567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOOKESH | ||||||||
| FirstName: | MARCIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 290 | ||||||||
| Address2: | |||||||||
| City: | ANGOON | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998200290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077884632 | ||||||||
| FaxNumber: | 9077883180 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 RELAY RD | ||||||||
| Address2: | |||||||||
| City: | ANGOON | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998200725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077884632 | ||||||||
| FaxNumber: | 9077883180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | AK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.