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General NPI Number Information
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NPI Number | 1881708832
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Entity Type | Organization
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Legal Business Name | ALPINE COUNSELING, PLLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 2235 E 25TH ST STE 220
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7530
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Country | US
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Telephone | 208-522-9812
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Fax | 208-522-9859
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Provider Business Mailing Address
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Address Line | 2235 E 25TH ST STE 220
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7530
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Country | US
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Telephone | 208-522-9812
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Fax | 208-522-9859
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MARIE HENG
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Credential | LCSW
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Telephone | 208-522-9812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 715
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC 267
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License Number State | ID
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