Provider Demographics
NPI:1093761439
Name:ASPEN BEHAVIORAL CARE
Entity Type:Organization
Organization Name:ASPEN BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-259-8583
Mailing Address - Street 1:3233 N ARLINGTON HEIGHTS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1557
Mailing Address - Country:US
Mailing Address - Phone:847-259-8583
Mailing Address - Fax:847-259-8935
Practice Address - Street 1:3233 N ARLINGTON HEIGHTS RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1557
Practice Address - Country:US
Practice Address - Phone:847-259-8583
Practice Address - Fax:847-259-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623169OtherBLUE CROSS BLUE SHIELD
IL789710000OtherMAGELLAN PROVIDER NUMBER
IL7604241OtherAETNA PROVIDER NUMBER
IL789710000OtherMAGELLAN PROVIDER NUMBER
WI000073206Medicare PIN
ILCH7909Medicare PIN