MEDICARE: INSPIRED GROWTH THERAPY PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1679340483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRED GROWTH THERAPY PLLC

Provider Business Mailing Address
First Line	:	1831 W WARNER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1862
Country	:	US
Telephone Number	:	574-514-2347
Fax Number	:

Provider Business Practice Location Address
First Line	:	4043 N RAVENSWOOD AVE STE 309-6
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1155
Country	:	US
Telephone Number	:	773-234-2428
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLY LYNN LEMAIRE
Credential	:	PHD
Telephone Number	:	773-234-2428

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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