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NPI Code Detail

MEDICARE: INSPIRE NEW BEGINNINGS LLC

MEDICARE: INSPIRE NEW BEGINNINGS 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
1251S00000XCommunity/Behavioral Health Agency7288-123WI

General Provider Information

NPI Number : 1871980920
Entity Type Code : Organization
Provider Name (Legal Business Name) : INSPIRE NEW BEGINNINGS LLC
Provider Business Mailing Address
First Line : 310 TIMBER TRAIL DR
Second Line :
City : WAUSAU
State : WI
Zip : 54403-9394
Country : US
Telephone Number : 715-551-7077
Fax Number :
Provider Business Practice Location Address
First Line : 530 GRANT ST
Second Line :
City : WAUSAU
State : WI
Zip : 54403-4738
Country : US
Telephone Number : 715-845-5493
Fax Number :
Authorized Official
Title or Position : LICENSED CLINICAL SOCIAL WORKER
Name : MRS. AMBER DAWN MYSKA
Credential : LCSW
Telephone Number : 715-551-7077
Provider Enumeration Date : 04/16/2015
Last Update Date : 04/16/2015

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Directions to “INSPIRE NEW BEGINNINGS LLC ” Practice Location

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