MEDICARE: ALPHA 180 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	101YP2500X	Professional Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1639670169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA 180 LLC

Provider Business Mailing Address
First Line	:	2416 S LAMAR BLVD STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 S LAMAR BLVD STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-4709
Country	:	US
Telephone Number	:	919-606-7392
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF RECOVERY SERVICES
Name	:	NICOLAAS DOORN
Credential	:
Telephone Number	:	919-606-7392

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	12/16/2025

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Directions to “ALPHA 180 LLC ” Practice Location

Language	Start Address	Practice Location

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