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General NPI Number Information
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NPI Number | 1548274202
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Entity Type | Organization
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Legal Business Name | ALPINE CLINIC, LLC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 3660 ROME DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-4488
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Country | US
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Telephone | 765-446-9394
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Fax | 765-447-8875
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Provider Business Mailing Address
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Address Line | 3660 ROME DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-4488
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Country | US
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Telephone | 765-446-9394
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Fax | 765-447-8875
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | NIZAR EL-KHALILI
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Credential | M.D.
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Telephone | 765-446-9394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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