Provider Demographics
NPI:1619551066
Name:INSPIRATIONAL BEHAVIOR HEALTH CLINIC
Entity Type:Organization
Organization Name:INSPIRATIONAL BEHAVIOR HEALTH CLINIC
Other - Org Name:INSPIRATIONAL BEHAVIOR HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DZAMESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-717-1729
Mailing Address - Street 1:4219 EDENDALE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8632
Mailing Address - Country:US
Mailing Address - Phone:661-717-1729
Mailing Address - Fax:
Practice Address - Street 1:4219 EDENDALE CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8632
Practice Address - Country:US
Practice Address - Phone:661-717-1729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center