Provider Demographics
NPI:1447227731
Name:ASPEN GROVE COUNSELING, LLC
Entity type:Organization
Organization Name:ASPEN GROVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-581-0422
Mailing Address - Street 1:1400 FOOTHILL DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2327
Mailing Address - Country:US
Mailing Address - Phone:801-581-0422
Mailing Address - Fax:801-581-0764
Practice Address - Street 1:1400 FOOTHILL DR
Practice Address - Street 2:SUITE 24
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2327
Practice Address - Country:US
Practice Address - Phone:801-581-0422
Practice Address - Fax:801-581-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49222542501103T00000X
UT37632535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty