Healthcare Provider Details

I. General information

NPI: 1366312233
Provider Name (Legal Business Name): ALPENGLOW HOLISTIC THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 E 6990 S
MIDVALE UT
84047-1641
US

IV. Provider business mailing address

386 E 6990 S
MIDVALE UT
84047-1641
US

V. Phone/Fax

Practice location:
  • Phone: 801-849-3435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REBECCA RUDA
Title or Position: DIRECTOR
Credential: CMHC
Phone: 801-849-3435