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General NPI Number Information
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NPI Number | 1184229304
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Entity Type | Organization
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Legal Business Name | ASPIRE INTEGRATIVE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 3142 W BELLTOWER DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4882
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Country | US
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Telephone | 208-598-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 3142 W BELLTOWER DR
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City | MERIDIAN
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State | ID
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Zip | 83646-4882
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Country | US
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Telephone | 208-598-6348
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | CYNTHIA G MEDRANO
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Credential | PMHNP
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Telephone | 361-331-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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