Healthcare Provider Details

I. General information

NPI: 1336859149
Provider Name (Legal Business Name): INSPIRING GROWTH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 CROSSBRIDGE BLVD.
BYRAM MS
39272
US

IV. Provider business mailing address

2104 CROSSBRIDGE BLVD.
BYRAM MS
39272
US

V. Phone/Fax

Practice location:
  • Phone: 601-985-7058
  • Fax:
Mailing address:
  • Phone: 601-985-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KORLYNN TRICE
Title or Position: BILLING MANAGER
Credential: MHA
Phone: 601-624-5912