Provider Demographics
NPI:1598513749
Name:ASPENGLOW THERAPY COMPANY, PLLC
Entity type:Organization
Organization Name:ASPENGLOW THERAPY COMPANY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:BRITTANI MASSEY
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ADDC
Authorized Official - Phone:502-295-0274
Mailing Address - Street 1:860 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-6702
Mailing Address - Country:US
Mailing Address - Phone:502-295-0274
Mailing Address - Fax:
Practice Address - Street 1:326 MAIN ST STE 200C
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1862
Practice Address - Country:US
Practice Address - Phone:502-295-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000197747Medicaid
1629651401OtherNPI