Provider Demographics
NPI:1437963733
Name:ASPEN PSYCHIATRY LLC
Entity type:Organization
Organization Name:ASPEN PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-719-0098
Mailing Address - Street 1:1675 W 11TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3711
Mailing Address - Country:US
Mailing Address - Phone:480-608-0291
Mailing Address - Fax:
Practice Address - Street 1:1675 W 11TH AVE STE C
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3711
Practice Address - Country:US
Practice Address - Phone:480-608-0291
Practice Address - Fax:480-608-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)