Provider Demographics
NPI:1912310368
Name:ASPIRE MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:ASPIRE MENTAL HEALTH LLC
Other - Org Name:CHRISTINE MICHELLE FORMICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCANINCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-673-7462
Mailing Address - Street 1:2980 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6531
Mailing Address - Country:US
Mailing Address - Phone:702-673-7462
Mailing Address - Fax:702-442-8900
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-673-7462
Practice Address - Fax:702-442-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6553-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty