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General NPI Number Information
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NPI Number | 1679340483
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Entity Type | Organization
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Legal Business Name | INSPIRED GROWTH THERAPY PLLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 4043 N RAVENSWOOD AVE STE 309-6
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City | CHICAGO
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State | IL
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Zip | 60613-1155
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Country | US
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Telephone | 773-234-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 1831 W WARNER AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60613-1862
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Country | US
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Telephone | 574-514-2347
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY LYNN LEMAIRE
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Credential | PHD
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Telephone | 773-234-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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