1699472969 NPI number — ASPEN GROVE MENTAL HEALTH PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699472969 NPI number — ASPEN GROVE MENTAL HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN GROVE MENTAL HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699472969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 HIGH POINT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRMONT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26554-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-204-3633
Provider Business Mailing Address Fax Number:
719-249-4018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 HIGH ST STE 816
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505-5448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-838-4316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
NIEMANN
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-204-3633

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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