Provider Demographics
NPI:1962882233
Name:INSPIRE PSYCHOLOGICAL CENTER, LLC
Entity type:Organization
Organization Name:INSPIRE PSYCHOLOGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIANNE
Authorized Official - Middle Name:LEMOS
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:307-679-9057
Mailing Address - Street 1:632 COFFEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5314
Mailing Address - Country:US
Mailing Address - Phone:307-655-5510
Mailing Address - Fax:
Practice Address - Street 1:632 COFFEEN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:NY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-655-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty