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General NPI Number Information
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NPI Number | 1497280697
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Entity Type | Organization
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Legal Business Name | INSPIRED WELLNESS LLC
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 145 S HOLLY ST STE B
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City | MEDFORD
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State | OR
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Zip | 97501-3101
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Country | US
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Telephone | 541-500-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 1883 ORANGEWOOD DR
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City | MEDFORD
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State | OR
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Zip | 97504-5727
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Country | US
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Telephone | 541-499-7225
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | KANDI OBRIST
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Credential | LPC
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Telephone | 541-499-7225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C3111
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License Number State | OR
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