Provider Demographics
NPI:1902494685
Name:ASPIRE CHANGE LLC
Entity Type:Organization
Organization Name:ASPIRE CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-202-3211
Mailing Address - Street 1:20411 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:MO
Mailing Address - Zip Code:65013-2144
Mailing Address - Country:US
Mailing Address - Phone:573-202-3211
Mailing Address - Fax:
Practice Address - Street 1:20411 HIGHWAY M
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:MO
Practice Address - Zip Code:65013-2144
Practice Address - Country:US
Practice Address - Phone:573-202-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty