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General NPI Number Information
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NPI Number | 1053086587
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Entity Type | Organization
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Legal Business Name | ASPIRE365 CONNECTICUT
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 679 STATE ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-6509
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Country | US
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Telephone | 385-352-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 9350 S 150 E STE 320
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City | SANDY
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State | UT
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Zip | 84070-2707
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Country | US
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Telephone | 385-352-9696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ZACHARY JENSON
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Credential |
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Telephone | 801-556-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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