MEDICARE: ASPIRE COUNSELING AND CONSULTING SERVICES

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	251S00000X	Community/Behavioral Health Agency	2305C	AL

General Provider Information

NPI Number	:	1720434939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE COUNSELING AND CONSULTING SERVICES

Provider Business Mailing Address
First Line	:	129 LAUREL OAK RD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-9073
Country	:	US
Telephone Number	:	256-651-6562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 MCMURTRIE DR NW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2469
Country	:	US
Telephone Number	:	256-434-1246
Fax Number	:	888-502-0641

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	CHOYA REGINALD WISE
Credential	:	LCSW
Telephone Number	:	256-651-6562

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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