MEDICARE: ASPIRE COUNSELING SERVICES, 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	4224	LA

General Provider Information

NPI Number	:	1497061253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 513
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70707-0513
Country	:	US
Telephone Number	:	225-921-8855
Fax Number	:	225-622-5289

Provider Business Practice Location Address
First Line	:	14635 S HARRELLS FERRY RD
Second Line	:	SUITE 6C
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2959
Country	:	US
Telephone Number	:	225-921-8855
Fax Number	:	225-622-5289

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DARYL HEBERT
Credential	:	LPC, LAC, CRC, SAP
Telephone Number	:	225-921-8855

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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