Provider Demographics
NPI:1740521871
Name:ASPIRE OCCUPATIONAL REHABILITATION, PLLC
Entity type:Organization
Organization Name:ASPIRE OCCUPATIONAL REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-855-5886
Mailing Address - Street 1:971 MAIN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4303
Mailing Address - Country:US
Mailing Address - Phone:304-855-5886
Mailing Address - Fax:304-855-5889
Practice Address - Street 1:971 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-4303
Practice Address - Country:US
Practice Address - Phone:304-855-5886
Practice Address - Fax:304-855-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV799103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001198Medicaid