MEDICARE: ASPIRING ANEW GENERATION CLINIC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility
3	101YM0800X	Mental Health Counselor
4	101YP1600X	Pastoral Counselor
5	101YP2500X	Professional Counselor
6	104100000X	Social Worker
7	106S00000X	Behavior Technician
8	251B00000X	Case Management Agency
9	261QC1500X	Community Health Clinic/Center
10	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
11	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760198329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRING ANEW GENERATION CLINIC LLC

Provider Business Mailing Address
First Line	:	4478 S MARION PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-4791
Country	:	US
Telephone Number	:	602-570-5633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E THOMAS RD STE K
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8218
Country	:	US
Telephone Number	:	480-382-2444
Fax Number	:	602-314-5813

Authorized Official
Title or Position	:	CEO
Name	:	DR. JESSICA STANFORD
Credential	:	PHD
Telephone Number	:	602-581-8860

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	03/21/2024

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