Provider Demographics
NPI:1871645044
Name:ASPEN MENTAL HEALTH
Entity Type:Organization
Organization Name:ASPEN MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-342-2950
Mailing Address - Street 1:7950 W. KING STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-342-2950
Mailing Address - Fax:208-323-1868
Practice Address - Street 1:7950 W. KING STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-342-2950
Practice Address - Fax:208-323-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805507700Medicaid
ID1578750592Medicare UPIN
ID805507700Medicaid