Provider Demographics
NPI:1770065716
Name:INSPIRE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:INSPIRE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NAYIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:620-952-1738
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:KS
Mailing Address - Zip Code:67855-0637
Mailing Address - Country:US
Mailing Address - Phone:620-952-1738
Mailing Address - Fax:620-492-3316
Practice Address - Street 1:613 W. NORTH AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:KS
Practice Address - Zip Code:67855637
Practice Address - Country:US
Practice Address - Phone:620-952-1738
Practice Address - Fax:620-492-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201119110BMedicaid