Healthcare Provider Details

I. General information

NPI: 1518217983
Provider Name (Legal Business Name): ASPENWOOD COUNSELING AND BEHAVIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ALBION AVE
BURLEY ID
83318-1817
US

IV. Provider business mailing address

1305 ALBION AVE
BURLEY ID
83318-1817
US

V. Phone/Fax

Practice location:
  • Phone: 208-878-9178
  • Fax:
Mailing address:
  • Phone: 208-878-9178
  • Fax: 208-878-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3745
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number3745
License Number StateID

VIII. Authorized Official

Name: JEANETTE M BERN
Title or Position: COUNSELOR
Credential: LCPC
Phone: 208-878-9178