Provider Demographics
NPI:1720295074
Name:ALPINE CENTER FOR PERSONAL GROWTH
Entity Type:Organization
Organization Name:ALPINE CENTER FOR PERSONAL GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-1715
Mailing Address - Street 1:5689 S REDWOOD RD # 30
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5322
Mailing Address - Country:US
Mailing Address - Phone:801-268-1715
Mailing Address - Fax:801-268-1783
Practice Address - Street 1:5689 S REDWOOD RD # 30
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-5322
Practice Address - Country:US
Practice Address - Phone:801-268-1715
Practice Address - Fax:801-268-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherTIN