Jason Bavilla
Counselor in Bethel, AK. Individual provider (NPI-1).
NPI number1962045757
StatusActive
Last updated in NPPESOct 24, 2019
Details
- NPI
- 1962045757
- Entity type
- Individual (NPI-1)
- Name
- Jason Bavilla
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 24, 2019
- Last updated
- Oct 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | – | – | Yes |
Practice location
829 Chief Eddie Hoffman HwyBethel, AK 99559-0528
Phone 907-543-6100 · Fax 907-543-6159
Mailing address
Po Box 528Bethel, AK 99559-0528
Phone 907-543-6100 · Fax 907-543-6159
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