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General NPI Number Information
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NPI Number | 1235079864
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Entity Type | Organization
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Legal Business Name | ASPEN GROVE CLINICAL SERVICES LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 3001 NORTHRIDGE DR # 7
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City | FARMINGTON
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State | NM
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Zip | 87401-2084
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Country | US
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Telephone | 505-330-1079
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | FARMINGTON
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State | NM
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Zip | 87499-0134
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Country | US
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Telephone | 505-330-1079
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Fax |
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Authorized Official
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Title or Position | CHEIF OPERATING OFFICER
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Name | MR. CLINTON T TAYLOR
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Credential | LCSW, LADAC
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Telephone | 505-330-1079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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