MEDICARE: ASPIRE PSYCHIATRIC SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1093231987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE PSYCHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	625 N 1ST ST STE C
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4138
Country	:	US
Telephone Number	:	501-985-0292
Fax Number	:	501-985-2070

Provider Business Practice Location Address
First Line	:	625 N 1ST ST STE C
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4138
Country	:	US
Telephone Number	:	501-985-0292
Fax Number	:	501-985-2070

Authorized Official
Title or Position	:	OWNER
Name	:	LOIS E WALKER
Credential	:	APN
Telephone Number	:	501-352-5164

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	07/21/2022

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