Provider Demographics
NPI:1104118132
Name:ASPEN RIDGE COUNSELING LLC
Entity type:Organization
Organization Name:ASPEN RIDGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:HAKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-414-3252
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-0330
Mailing Address - Country:US
Mailing Address - Phone:801-990-4300
Mailing Address - Fax:801-967-2127
Practice Address - Street 1:2711 S 8500 W
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1307
Practice Address - Country:US
Practice Address - Phone:801-990-4300
Practice Address - Fax:801-967-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT369489-35011041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty