Provider Demographics
NPI:1417376088
Name:ASPIRE WELLNESS GROUP
Entity Type:Organization
Organization Name:ASPIRE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-910-6323
Mailing Address - Street 1:1015 S 40TH AVE
Mailing Address - Street 2:#18
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3806
Mailing Address - Country:US
Mailing Address - Phone:509-965-0850
Mailing Address - Fax:509-895-7809
Practice Address - Street 1:1015 S 40TH AVE
Practice Address - Street 2:#18
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3806
Practice Address - Country:US
Practice Address - Phone:509-965-0850
Practice Address - Fax:509-895-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011570175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty