Healthcare Provider Details

I. General information

NPI: 1881708832
Provider Name (Legal Business Name): ALPINE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E 25TH ST STE 220
IDAHO FALLS ID
83404-7530
US

IV. Provider business mailing address

2235 E 25TH ST STE 220
IDAHO FALLS ID
83404-7530
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-9812
  • Fax: 208-522-9859
Mailing address:
  • Phone: 208-522-9812
  • Fax: 208-522-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 267
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 715
License Number StateID

VIII. Authorized Official

Name: SUSAN MARIE HENG
Title or Position: OWNER
Credential: LCSW
Phone: 208-522-9812