Healthcare Provider Details

I. General information

NPI: 1689910804
Provider Name (Legal Business Name): INSPIRE COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 N SHERIDAN RD STE N
PEORIA IL
61614-2848
US

IV. Provider business mailing address

6707 N SHERIDAN RD STE N
PEORIA IL
61614-2848
US

V. Phone/Fax

Practice location:
  • Phone: 309-648-1553
  • Fax: 309-691-7383
Mailing address:
  • Phone: 309-648-1553
  • Fax: 309-691-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007832
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149.015362
License Number StateIL

VIII. Authorized Official

Name: MRS. STACEY J MUNOZ
Title or Position: OWNER/PRESIDENT
Credential: LCPC
Phone: 309-453-3604