=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356877286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPEN COUNSELING SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 05/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8100 LOMO ALTO DR SUITE 238
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-983-6726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8100 LOMO ALTO DR SUITE 238
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-6530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-983-6726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MELISSA GAA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 214-983-6726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 74457
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------