=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891284436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPEN HEART HYPNOTHERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2018
-----------------------------------------------------
Last Update Date | 05/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 GARDEN CTR STE 162
-----------------------------------------------------
City | BROOMFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-433-1507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 GARDEN CTR STE 162
-----------------------------------------------------
City | BROOMFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80020-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-433-1507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOLE PROPRIETOR
-----------------------------------------------------
Name | ALANNA J BELL
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 970-433-1507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------