Provider Demographics
NPI:1003432683
Name:INSPIRE COUNSELING AND SUPPORT CENTER, INC
Entity Type:Organization
Organization Name:INSPIRE COUNSELING AND SUPPORT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLASANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-253-2575
Mailing Address - Street 1:3800 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3605
Practice Address - Country:US
Practice Address - Phone:316-202-7051
Practice Address - Fax:833-213-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004740460002Medicaid