Healthcare Provider Details

I. General information

NPI: 1154279339
Provider Name (Legal Business Name): ASPEN PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 L ST
ANCHORAGE AK
99501-1959
US

IV. Provider business mailing address

510 L ST
ANCHORAGE AK
99501-1959
US

V. Phone/Fax

Practice location:
  • Phone: 847-231-5211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL LU
Title or Position: PMHNP
Credential:
Phone: 847-109-6575