Provider Demographics
NPI:1649515834
Name:ALPINE COUNSELING CENTER
Entity type:Organization
Organization Name:ALPINE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-756-3664
Mailing Address - Street 1:475 W 50 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2265
Mailing Address - Country:US
Mailing Address - Phone:801-756-3664
Mailing Address - Fax:801-756-3698
Practice Address - Street 1:475 W 50 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2265
Practice Address - Country:US
Practice Address - Phone:801-756-3664
Practice Address - Fax:801-756-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1962103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty