Most Relevant Information
Provider Data
| NPI Number: | 1003285651 |
| Provider Name: | JONATHAN LIBERTY |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/24/2015 |
| Last Updated: | 09/24/2015 |
Provider Practice Location
835 CHIEF EDDIE HOFFMAN HIGHWAY
BETHEL
AK
99559
Practice Location Phone/Fax
| Phone: | 9075436552 |
| Fax: |
Provider Mailing Location
PO BOX 528
ATTN: BRC PROGRAM
BETHEL
AK
995590528
Provider Mailing Phone/Fax
| Phone: | 9075436552 |
| Fax: | 9075436712 |