MEDICARE: INSPIRE BEHAVIORAL LEARNING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1346724788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRE BEHAVIORAL LEARNING, LLC

Provider Business Mailing Address
First Line	:	2425 CHANNING WAY STE B
Second Line	:	PMB 454
City	:	BERKELEY
State	:	CA
Zip	:	94704-2260
Country	:	US
Telephone Number	:	510-296-5401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 CHANNING WAY STE B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2260
Country	:	US
Telephone Number	:	510-296-5401
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLY LYNN KNOWLES
Credential	:
Telephone Number	:	510-296-5401

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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