MEDICARE: INSPIRED HOPE MENTAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1407116866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRED HOPE MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	4005 PEPPER THORN AVE
Second Line	:	201
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3818
Country	:	US
Telephone Number	:	702-203-6524
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 PEPPER THORN AVE
Second Line	:	201
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3818
Country	:	US
Telephone Number	:	702-203-6524
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/OWNER
Name	:	TERRENCE M BOOTH
Credential	:
Telephone Number	:	702-203-6524

Provider Enumeration Date	:	05/19/2012
Last Update Date	:	05/21/2012

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