Healthcare Provider Details

I. General information

NPI: 1770065716
Provider Name (Legal Business Name): INSPIRE MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W. NORTH AVE
JOHNSON KS
67855637
US

IV. Provider business mailing address

PO BOX 637
JOHNSON KS
67855-0637
US

V. Phone/Fax

Practice location:
  • Phone: 620-952-1738
  • Fax: 620-492-3316
Mailing address:
  • Phone: 620-952-1738
  • Fax: 620-492-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4766
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201119110B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: NAYIVE ELLIS
Title or Position: SOCIAL WORKER
Credential: LSCSW
Phone: 620-952-1738