Basic Information
Provider Information
NPI: 1326288994
EntityType: 2
ReplacementNPI:  
OrganizationName: ASPEN COUNSELING & CONSULTING LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 8616 NORTHERN AVE
Address2:  
City: ROCKFORD
State: IL
PostalCode: 611075309
CountryCode: US
TelephoneNumber: 8153999700
FaxNumber: 8153941401
Practice Location
Address1: 1021 N MULFORD RD
Address2: L1
City: ROCKFORD
State: IL
PostalCode: 611073877
CountryCode: US
TelephoneNumber: 8153999700
FaxNumber: 8153941401
Other Information
ProviderEnumerationDate: 02/23/2009
LastUpdateDate: 12/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: EATON
AuthorizedOfficialFirstName: PHILIP
AuthorizedOfficialMiddleName: W
AuthorizedOfficialTitleorPosition: PRESIDENT / CEO
AuthorizedOfficialTelephone: 8153911000
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ROSECRANCE, INC
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MASTERS OF SCIENCE
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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