Provider Demographics
NPI:1689317612
Name:MYSUSPIRE, INC
Entity Type:Organization
Organization Name:MYSUSPIRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-521-1978
Mailing Address - Street 1:2288 GUNBARREL RD STE 154-165
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2609
Mailing Address - Country:US
Mailing Address - Phone:423-521-1978
Mailing Address - Fax:
Practice Address - Street 1:191 BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-8378
Practice Address - Country:US
Practice Address - Phone:951-205-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)