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General NPI Number Information
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NPI Number | 1669824744
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Entity Type | Organization
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Legal Business Name | ASPIRE BEHAVIORAL THERAPY, LLC
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 343 S MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320
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Country | US
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Telephone | 270-228-2414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 292
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City | BEAVER DAM
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State | KY
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Zip | 42320-0292
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | WENDY RUSSELL
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Credential | LPCC
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Telephone | 270-228-2414
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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 | 163595
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License Number State | KY
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