Provider Demographics
NPI:1609316116
Name:ALPHA NEUROHEALTH CLINIC
Entity Type:Organization
Organization Name:ALPHA NEUROHEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-574-5590
Mailing Address - Street 1:169 W 2710 SOUTH CIR STE 201C
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7201
Mailing Address - Country:US
Mailing Address - Phone:435-574-5590
Mailing Address - Fax:435-574-5591
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 201C
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7201
Practice Address - Country:US
Practice Address - Phone:435-574-5590
Practice Address - Fax:435-574-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00040245261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)