Provider Demographics
NPI:1679701312
Name:ALPENGLOW COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ALPENGLOW COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-690-7814
Mailing Address - Street 1:PO BOX 6820
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-6820
Mailing Address - Country:US
Mailing Address - Phone:307-690-7814
Mailing Address - Fax:
Practice Address - Street 1:357 W. DELONEY
Practice Address - Street 2:C-17
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-690-7814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1085251S00000X
TN1534251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health