=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225584519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPEN WIND COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2016
-----------------------------------------------------
Last Update Date | 08/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 191 E. AGATE
-----------------------------------------------------
City | GRANBY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-531-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 903
-----------------------------------------------------
City | GRAND LAKE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-531-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATIE EASTMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 970-531-0501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0011384
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------