Basic Information
| Provider Information | |||||||||
| NPI: | 1881708832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPINE COUNSELING, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2235 E 25TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085229812 | ||||||||
| FaxNumber: | 2085229859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2235 E 25TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834047530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085229812 | ||||||||
| FaxNumber: | 2085229859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | HENG | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2085229812 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW 715 | ID | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | LCPC 267 | ID | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.