Healthcare Provider Details

I. General information

NPI: 1306094578
Provider Name (Legal Business Name): INSPIRATION BEHAVIORAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W CHARLESTON BLVD STE 170
LAS VEGAS NV
89102-1682
US

IV. Provider business mailing address

3900 W CHARLESTON BLVD STE 170
LAS VEGAS NV
89102-1682
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-4673
  • Fax: 702-453-2673
Mailing address:
  • Phone: 702-453-4673
  • Fax: 702-453-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2531-C
License Number StateNV

VIII. Authorized Official

Name: MRS. PRISCILLA V OTOO-DAVIS
Title or Position: CEO
Credential: M.S.W.
Phone: 702-453-4673