Provider Demographics
NPI:1790243855
Name:ASPEN CENTER4COUNSELING, LLC
Entity Type:Organization
Organization Name:ASPEN CENTER4COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-925-9462
Mailing Address - Street 1:135 W MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1700
Mailing Address - Country:US
Mailing Address - Phone:817-925-9462
Mailing Address - Fax:
Practice Address - Street 1:135 W MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1700
Practice Address - Country:US
Practice Address - Phone:817-925-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134354996OtherNPPES