Provider Demographics
NPI:1518217983
Name:ASPENWOOD COUNSELING AND BEHAVIOR CENTER
Entity Type:Organization
Organization Name:ASPENWOOD COUNSELING AND BEHAVIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-312-2510
Mailing Address - Street 1:BOX 111
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ID
Mailing Address - Zip Code:83311
Mailing Address - Country:US
Mailing Address - Phone:208-312-2510
Mailing Address - Fax:
Practice Address - Street 1:225 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:ID
Practice Address - Zip Code:83311-0111
Practice Address - Country:US
Practice Address - Phone:208-312-2510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3745261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health