Provider Demographics
NPI:1558954008
Name:ASPENRIDGE NORTH
Entity Type:Organization
Organization Name:ASPENRIDGE NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-282-1734
Mailing Address - Street 1:706 S COLLEGE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-9860
Mailing Address - Country:US
Mailing Address - Phone:970-875-6116
Mailing Address - Fax:
Practice Address - Street 1:706 S COLLEGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-9860
Practice Address - Country:US
Practice Address - Phone:970-875-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPENRIDGE NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1774-01OtherOBH STATE LICENSE