MEDICARE: ASPEN BEHAVIORAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist
2	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21623169	OTHER	IL	BLUE CROSS BLUE SHIELD
2	789710000	OTHER	IL	MAGELLAN PROVIDER NUMBER
3	7604241	OTHER	IL	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1093761439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN BEHAVIORAL CARE

Provider Business Mailing Address
First Line	:	3233 N ARLINGTON HEIGHTS RD STE 100
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1557
Country	:	US
Telephone Number	:	847-259-8583
Fax Number	:	847-259-8935

Provider Business Practice Location Address
First Line	:	3233 N ARLINGTON HEIGHTS RD STE 100
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1557
Country	:	US
Telephone Number	:	847-259-8583
Fax Number	:	847-259-8935

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARK FREDERICK FRAZIER
Credential	:	PSY.D.
Telephone Number	:	847-259-8583

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/09/2020

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Directions to “ASPEN BEHAVIORAL CARE ” Practice Location

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