=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255731493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRE CONSULTING AND THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2014
-----------------------------------------------------
Last Update Date | 08/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 E GOLF RD STE 115 SUITE 115
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-4049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-258-7273
-----------------------------------------------------
Fax | 847-981-0876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 E GOLF RD STE 115 SUITE 115
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-4049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-258-7273
-----------------------------------------------------
Fax | 847-981-0876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MARRIAGE & FAM THERAPIST
-----------------------------------------------------
Name | DR. MUDITA RASTOGI
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 847-258-7273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 166-000369
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------