Organization
ALPINE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIZAR EL-KHALILI M.D. (OWNER/MEDICAL DIRECTOR)
(765) 446-9394
Entity
Organization
Contact information
Practice address
3660 ROME DR, LAFAYETTE, IN 47905-4488
(765) 446-9394
(765) 447-8875
Mailing address
3660 ROME DR, LAFAYETTE, IN 47905-4488
(765) 446-9394
(765) 447-8875
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200239900A
—
IN
Enumeration date
07/28/2006
Last updated
07/20/2010
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