Provider Demographics
NPI:1689632309
Name:ASPEN FAMILY COUNSELING
Entity Type:Organization
Organization Name:ASPEN FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ERATH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-742-5020
Mailing Address - Street 1:2639 NEW PINERY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1110
Mailing Address - Country:US
Mailing Address - Phone:608-742-5020
Mailing Address - Fax:608-742-3641
Practice Address - Street 1:2639 NEW PINERY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1110
Practice Address - Country:US
Practice Address - Phone:608-742-5020
Practice Address - Fax:608-742-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI570028OtherDEAN HEALTHCARE PROVIDER
WI81145030OtherTHE ALLIANCE PROVIDER #
WI42202000Medicaid
WI42202000Medicaid
WI42202000Medicaid