MEDICARE: INSPIRATIONS FOR YOUTH AND FAMILIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093987463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRATIONS FOR YOUTH AND FAMILIES LLC

Provider Business Mailing Address
First Line	:	24 SW 10TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1272
Country	:	US
Telephone Number	:	954-376-4783
Fax Number	:	954-765-0787

Provider Business Practice Location Address
First Line	:	1216 SE 1ST AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1802
Country	:	US
Telephone Number	:	954-376-4783
Fax Number	:	954-765-0787

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER WALSH
Credential	:
Telephone Number	:	954-376-4783

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	09/02/2016

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