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General NPI Number Information
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NPI Number | 1164217873
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Entity Type | Organization
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Legal Business Name | INSPIRE CHANGE THERAPEUTIC SERVICES PLLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 30410 HIGHWAY 200 # 200R-3
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City | PONDERAY
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State | ID
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Zip | 83852-9601
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Country | US
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Telephone | 208-290-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 30410 HIGHWAY 200 STE 200R-3
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City | PONDERAY
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State | ID
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Zip | 83852-9601
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Country | US
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Telephone | 208-610-4861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAELLA A HAMMERSBERG
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Credential | LCSW
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Telephone | 208-610-4861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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