Provider Demographics
NPI:1528423985
Name:ALVIG, ALLEN BRUCE (LADC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:BRUCE
Last Name:ALVIG
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MILLER ST
Mailing Address - Street 2:P.O. BOX 219
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-4333
Mailing Address - Country:US
Mailing Address - Phone:218-385-2991
Mailing Address - Fax:218-385-2992
Practice Address - Street 1:102 MILLER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4333
Practice Address - Country:US
Practice Address - Phone:218-385-2991
Practice Address - Fax:218-385-2992
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)