Healthcare Provider Details

I. General information

NPI: 1295139210
Provider Name (Legal Business Name): ASPIRE BEHAVIORAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12913 LUCILLE ST
OVERLAND PARK KS
66213-4466
US

IV. Provider business mailing address

12913 LUCILLE ST
OVERLAND PARK KS
66213-4466
US

V. Phone/Fax

Practice location:
  • Phone: 913-802-2227
  • Fax: 913-273-0235
Mailing address:
  • Phone: 913-802-2227
  • Fax: 913-273-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2011031042
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2011031042
License Number StateMO

VIII. Authorized Official

Name: MRS. LYDIA JENNINGS
Title or Position: DIRECTOR
Credential: BCBA
Phone: 913-802-2227