Healthcare Provider Details

I. General information

NPI: 1184949653
Provider Name (Legal Business Name): ASPEN COUNSELING AND RECOVERY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ELM AVE SUITE 2
MUNISING MI
49862-1108
US

IV. Provider business mailing address

202 ELM AVE SUITE 2
MUNISING MI
49862-1108
US

V. Phone/Fax

Practice location:
  • Phone: 906-387-1030
  • Fax: 906-387-1038
Mailing address:
  • Phone: 906-387-1030
  • Fax: 906-387-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009362
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085455
License Number StateMI

VIII. Authorized Official

Name: ELIZABETH PANGRAZZI
Title or Position: OWNER
Credential: MA,LLP
Phone: 906-387-1030