Healthcare Provider Details

I. General information

NPI: 1326218454
Provider Name (Legal Business Name): ALLIANCE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 S COLUMBIA LN
OREM UT
84097-8002
US

IV. Provider business mailing address

71 N 490 W
AMERICAN FORK UT
84003-2264
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-4508
  • Fax: 801-225-4386
Mailing address:
  • Phone: 801-763-7775
  • Fax: 801-763-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CLARISSE CHADWICK
Title or Position: PARTNER/THERAPIST
Credential: LPC
Phone: 801-225-4508