Provider Demographics
NPI:1487841557
Name:ASPEN THERAPY INC
Entity Type:Organization
Organization Name:ASPEN THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KILLPACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-225-3111
Mailing Address - Street 1:3707 N CANYON RD # 2C
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4596
Mailing Address - Country:US
Mailing Address - Phone:801-225-3111
Mailing Address - Fax:801-225-9809
Practice Address - Street 1:3707 N CANYON RD # 2C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4596
Practice Address - Country:US
Practice Address - Phone:801-225-3111
Practice Address - Fax:801-225-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116278-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty