Provider Demographics
NPI:1003591801
Name:INSPIRATION PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:INSPIRATION PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:MI
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-721-3541
Mailing Address - Street 1:66 CEDAR ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2655
Mailing Address - Country:US
Mailing Address - Phone:866-333-9758
Mailing Address - Fax:866-299-1960
Practice Address - Street 1:66 CEDAR ST STE 204
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2655
Practice Address - Country:US
Practice Address - Phone:866-333-9758
Practice Address - Fax:866-299-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1174097331OtherINDIVIDUAL NPI