Healthcare Provider Details

I. General information

NPI: 1962882233
Provider Name (Legal Business Name): INSPIRE PSYCHOLOGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 COFFEEN AVE
SHERIDAN NY
82801
US

IV. Provider business mailing address

632 COFFEEN AVE
SHERIDAN WY
82801-5314
US

V. Phone/Fax

Practice location:
  • Phone: 307-655-5510
  • Fax:
Mailing address:
  • Phone: 307-655-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIANNE LEMOS TRAN
Title or Position: OWNER
Credential: PSY.D.
Phone: 307-679-9057