MEDICARE: ASPIRE FAMILY COUNSELING AND 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	261QM0850X	Adult Mental Health Clinic/Center
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1710717343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRE FAMILY COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	3736 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	479-633-7423
Fax Number	:	833-427-1422

Provider Business Practice Location Address
First Line	:	3736 ROGERS AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2984
Country	:	US
Telephone Number	:	479-633-7423
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KIMBERLY ANN MOORE
Credential	:	LPC, LMFT
Telephone Number	:	479-633-7423

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/19/2024

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