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General NPI Number Information
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NPI Number | 1275343006
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Entity Type | Organization
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Legal Business Name | ASPIRE365 SOUTH CAROLINA LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 141 TRACTION ST
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City | GREENVILLE
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State | SC
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Zip | 29611-4725
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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 | ZACHARY JENSON
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Credential |
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Telephone | 385-352-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 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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Taxonomy #3
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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 #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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