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General NPI Number Information
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NPI Number | 1689632309
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Entity Type | Organization
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Legal Business Name | ASPEN FAMILY COUNSELING
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2639 NEW PINERY RD SUITE 1
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City | PORTAGE
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State | WI
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Zip | 53901-1110
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Country | US
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Telephone | 608-742-5020
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Fax | 608-742-3641
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Provider Business Mailing Address
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Address Line | 2639 NEW PINERY RD SUITE 1
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City | PORTAGE
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State | WI
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Zip | 53901-1110
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Country | US
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Telephone | 608-742-5020
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Fax | 608-742-3641
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. BARRY D ERATH
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Credential | LCSW
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Telephone | 608-742-5020
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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 | 1066
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License Number State | WI
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