Provider Demographics
NPI:1902356181
Name:ASPIRE ICT, LLC
Entity Type:Organization
Organization Name:ASPIRE ICT, LLC
Other - Org Name:ALICIA LANDRUM LPC LMAC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMAC
Authorized Official - Phone:316-347-7171
Mailing Address - Street 1:8406 W. MAPLE ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1470
Mailing Address - Country:US
Mailing Address - Phone:316-347-7171
Mailing Address - Fax:316-462-0920
Practice Address - Street 1:8406 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1470
Practice Address - Country:US
Practice Address - Phone:316-347-7171
Practice Address - Fax:316-462-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS073101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty