Provider Demographics
NPI:1205036050
Name:INSPIRATION PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:INSPIRATION PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:TRIBULATO
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-907-2778
Mailing Address - Street 1:2535 TOWNSGATE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5976
Mailing Address - Country:US
Mailing Address - Phone:805-907-2778
Mailing Address - Fax:
Practice Address - Street 1:2535 TOWNSGATE RD STE 209
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5976
Practice Address - Country:US
Practice Address - Phone:805-907-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty