MEDICARE: ASPEN COUNSELING & CONSULTING LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326288994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN COUNSELING & CONSULTING LLC

Provider Business Mailing Address
First Line	:	8616 NORTHERN AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5309
Country	:	US
Telephone Number	:	815-399-9700
Fax Number	:	815-394-1401

Provider Business Practice Location Address
First Line	:	1021 N MULFORD RD
Second Line	:	L1
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-399-9700
Fax Number	:	815-394-1401

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. PHILIP W EATON
Credential	:	MASTERS OF SCIENCE
Telephone Number	:	815-391-1000

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	12/09/2016

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