Healthcare Provider Details

I. General information

NPI: 1992941728
Provider Name (Legal Business Name): ASPIRE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SELBY AVE SUITE 102
SAINT PAUL MN
55104-6221
US

IV. Provider business mailing address

1595 SELBY AVE SUITE 102
SAINT PAUL MN
55104-6221
US

V. Phone/Fax

Practice location:
  • Phone: 612-220-6020
  • Fax:
Mailing address:
  • Phone: 612-220-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAUL D. JANDL
Title or Position: CO-OWNER
Credential: M.D.
Phone: 612-822-5557