Doctor Name: | ALLEN BRUCE ALVIG |
NPI Number: | 1528423985 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.A.D.C. |
License Number: | 301295 |
Business Practice Address: | 102 Miller St New York Mills, MN - 565674333 |
Business Phone Number: | 2183852991 |
Business Fax Number: | 2183852992 |
Mailing Address: | 102 Miller St, P.o. Box 219 NEW YORK MILLS |
State: | MN |
Postal Code: | 565674333 |
Phone Number: | 2183852991 |
Fax Number: | 2183852992 |
NPI Enumeration Date: | 12/29/2015 |
NPI Last Update Date: | 12/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 301295 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |