Healthcare Provider Details

I. General information

NPI: 1164217873
Provider Name (Legal Business Name): INSPIRE CHANGE THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30410 HIGHWAY 200 # 200R-3
PONDERAY ID
83852-9601
US

IV. Provider business mailing address

30410 HIGHWAY 200 STE 200R-3
PONDERAY ID
83852-9601
US

V. Phone/Fax

Practice location:
  • Phone: 208-290-5285
  • Fax:
Mailing address:
  • Phone: 208-610-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHAELLA A HAMMERSBERG
Title or Position: OWNER
Credential: LCSW
Phone: 208-610-4861