MEDICARE: ALPENGLOW MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1427924398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPENGLOW MENTAL HEALTH

Provider Business Mailing Address
First Line	:	7950 MOORSBRIDGE RD STE 305
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-4420
Country	:	US
Telephone Number	:	269-222-2109
Fax Number	:	800-350-5021

Provider Business Practice Location Address
First Line	:	7950 MOORSBRIDGE RD STE 305
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-4420
Country	:	US
Telephone Number	:	269-222-2109
Fax Number	:	800-350-5021

Authorized Official
Title or Position	:	PHYSICIAN/PROPRIETOR
Name	:	SUZANNE HUBERTY
Credential	:	MD
Telephone Number	:	269-222-2109

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	12/05/2025

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Directions to “ALPENGLOW MENTAL HEALTH ” Practice Location

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