| Aspen Psychological Consulting, Llc | |
|
5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 | |
| (612) 367-7103 | |
| Not Available |
| Full Name | Aspen Psychological Consulting, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 5353 Gamble Dr Ste 395, St Louis Park, Minnesota |
| Authorized Official Name and Position | Jan Ellyn Tyson Roberts (OWNER) |
| Authorized Official Contact | 6123677103 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspen Psychological Consulting, Llc 1660 Highway 100 S Ste 332 St Louis Park MN 55416-1573 Ph: (612) 367-7103 | Aspen Psychological Consulting, Llc 5353 Gamble Dr Ste 395 St Louis Park MN 55416-1510 Ph: (612) 367-7103 |
| NPI Number | 1326486507 |
|---|---|
| Provider Enumeration Date | 06/10/2013 |
| Last Update Date | 02/04/2021 |
| Certification Date | 02/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326486507 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 5330 (Minnesota) | Primary |
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