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General NPI Number Information
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NPI Number | 1003340779
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Entity Type | Organization
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Legal Business Name | ASPIRE COUNSELING CONSULTING AND CREATIVE SOLUTIONS
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 501 N RIVERSIDE DR 111
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City | GURNEE
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State | IL
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Zip | 60031-5918
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Country | US
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Telephone | 847-946-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 501 N RIVERSIDE DR 111
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City | GURNEE
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State | IL
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Zip | 60031-5918
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Country | US
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Telephone | 847-946-5105
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JASMINE ALEGRA TUDY
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Credential | LMFT
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Telephone | 847-946-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.010922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000785
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License Number State | IL
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