Healthcare Provider Details

I. General information

NPI: 1720295074
Provider Name (Legal Business Name): ALPINE CENTER FOR PERSONAL GROWTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5689 S REDWOOD RD # 30
SALT LAKE CITY UT
84123-5322
US

IV. Provider business mailing address

5689 S REDWOOD RD # 30
SALT LAKE CITY UT
84123-5322
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-1715
  • Fax: 801-268-1783
Mailing address:
  • Phone: 801-268-1715
  • Fax: 801-268-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/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: HEATHER MICHELLE CHILD
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 801-268-1715