Provider Demographics
NPI:1447546221
Name:ASPIRE NEUROSCIENCES
Entity type:Organization
Organization Name:ASPIRE NEUROSCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-489-2238
Mailing Address - Street 1:5901 CAMINO CORTO NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6154
Mailing Address - Country:US
Mailing Address - Phone:505-489-2238
Mailing Address - Fax:
Practice Address - Street 1:5901 CAMINO CORTO NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6154
Practice Address - Country:US
Practice Address - Phone:505-489-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1480-082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty