Provider Demographics
NPI:1033609474
Name:ASPEN MENTAL HEALTH THERAPY AND CONSULTING, PLLC
Entity type:Organization
Organization Name:ASPEN MENTAL HEALTH THERAPY AND CONSULTING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:336-827-0089
Mailing Address - Street 1:221 THORNECLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:STATE ROAD
Mailing Address - State:NC
Mailing Address - Zip Code:28676-9263
Mailing Address - Country:US
Mailing Address - Phone:336-827-0089
Mailing Address - Fax:844-676-0500
Practice Address - Street 1:14072 ELKIN HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-9199
Practice Address - Country:US
Practice Address - Phone:336-827-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11973101Y00000X
261QM0801X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)