Provider Demographics
NPI:1790111466
Name:INSPIRED LIVES COUNSELING
Entity Type:Organization
Organization Name:INSPIRED LIVES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:659-273-3293
Mailing Address - Street 1:2309 PALMETTO AVE
Mailing Address - Street 2:C1
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2736
Mailing Address - Country:US
Mailing Address - Phone:650-273-3293
Mailing Address - Fax:
Practice Address - Street 1:2309 PALMETTO AVE
Practice Address - Street 2:C1
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2736
Practice Address - Country:US
Practice Address - Phone:650-273-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45739251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health