Provider Demographics
NPI:1508036955
Name:ALLIANCE CLINICAL SERVICES
Entity Type:Organization
Organization Name:ALLIANCE CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHADWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:801-763-7775
Mailing Address - Street 1:71 N 490 W
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2264
Mailing Address - Country:US
Mailing Address - Phone:801-763-7775
Mailing Address - Fax:801-763-7651
Practice Address - Street 1:71 N 490 W
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2264
Practice Address - Country:US
Practice Address - Phone:801-763-7775
Practice Address - Fax:801-763-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty