Healthcare Provider Details

I. General information

NPI: 1568169365
Provider Name (Legal Business Name): ASPIRE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 6TH ST
E LIVERPOOL OH
43920-2802
US

IV. Provider business mailing address

236 W 6TH ST
E LIVERPOOL OH
43920-2802
US

V. Phone/Fax

Practice location:
  • Phone: 330-932-1823
  • Fax: 330-932-1832
Mailing address:
  • Phone: 330-932-1823
  • Fax: 330-932-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JOSEPH
Title or Position: OWNER
Credential:
Phone: 330-853-6477