Provider Demographics
NPI:1386177681
Name:ALPHA CENTER SOCIAL WORK COUNSELING & CONSULTATION SERVICES, PLLC
Entity type:Organization
Organization Name:ALPHA CENTER SOCIAL WORK COUNSELING & CONSULTATION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-749-9944
Mailing Address - Street 1:1289 W 350 N
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4112
Mailing Address - Country:US
Mailing Address - Phone:435-749-9944
Mailing Address - Fax:
Practice Address - Street 1:375 S CARBON AVE
Practice Address - Street 2:SUITE 132
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2909
Practice Address - Country:US
Practice Address - Phone:435-749-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)