Provider Demographics
NPI:1164964813
Name:ALPINE'S EMPOWERMENT AGENCY
Entity Type:Organization
Organization Name:ALPINE'S EMPOWERMENT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-516-3718
Mailing Address - Street 1:2055 CRAIGSHIRE RD STE 350D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4028
Mailing Address - Country:US
Mailing Address - Phone:314-516-3718
Mailing Address - Fax:720-835-0032
Practice Address - Street 1:2055 CRAIGSHIRE RD STE 350D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4028
Practice Address - Country:US
Practice Address - Phone:314-516-3718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000746101YA0400X
CONLC.0104164101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500105643Medicaid