Provider Demographics
NPI:1326486507
Name:ASPEN PSYCHOLOGICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:ASPEN PSYCHOLOGICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:ELLYN
Authorized Official - Last Name:TYSON ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-367-7103
Mailing Address - Street 1:1660 HIGHWAY 100 S STE 332
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1573
Mailing Address - Country:US
Mailing Address - Phone:612-367-7103
Mailing Address - Fax:
Practice Address - Street 1:5353 GAMBLE DR STE 395
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1510
Practice Address - Country:US
Practice Address - Phone:612-367-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5330261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health