Provider Demographics
NPI:1063634327
Name:ASPEN PRACTICE PC
Entity Type:Organization
Organization Name:ASPEN PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-294-9677
Mailing Address - Street 1:2810 CENTRAL AVE,
Mailing Address - Street 2:SUITE A
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4651
Mailing Address - Country:US
Mailing Address - Phone:406-294-9677
Mailing Address - Fax:
Practice Address - Street 1:2810 CENTRAL AVE,
Practice Address - Street 2:SUITE A
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4651
Practice Address - Country:US
Practice Address - Phone:406-294-9677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0492643Medicaid
MT1497795694OtherNPI TYPE 1