=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013362987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRE COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2016
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 461 COLONIAL AVE SW
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-8581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-235-9732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 HUNING RANCH LOOP W
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-235-9732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COUNSELOR/THERAPIST
-----------------------------------------------------
Name | MR. JOHN CROWL
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 505-235-9732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 40277
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------