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General NPI Number Information
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NPI Number | 1396185351
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Entity Type | Organization
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Legal Business Name | ASPEN MENTAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/04/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 600 CENTRAL AVE SUITE# 310
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City | GREAT FALLS
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State | MT
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Zip | 59401-3179
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Country | US
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Telephone | 406-899-3513
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Fax |
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Provider Business Mailing Address
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Address Line | 112 MARILLYN DR
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City | GREAT FALLS
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State | MT
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Zip | 59405-7258
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Country | US
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Telephone | 406-899-3513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LACEY BOND MCINTOSH
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Credential | APRN
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Telephone | 406-899-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26716
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License Number State | MT
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