Provider Demographics
NPI:1154729622
Name:ASPEN FAMILY CENTER OF ALABAMA
Entity type:Organization
Organization Name:ASPEN FAMILY CENTER OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ODANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:937-726-8629
Mailing Address - Street 1:336 RICHMAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-4418
Mailing Address - Country:US
Mailing Address - Phone:937-726-8629
Mailing Address - Fax:
Practice Address - Street 1:336 RICHMAR DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-4418
Practice Address - Country:US
Practice Address - Phone:937-726-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3623C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty