Provider Demographics
NPI:1669069175
Name:INSPIRE PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:INSPIRE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-200-6524
Mailing Address - Street 1:273 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3913
Mailing Address - Country:US
Mailing Address - Phone:229-200-6524
Mailing Address - Fax:
Practice Address - Street 1:110 KELLWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3263
Practice Address - Country:US
Practice Address - Phone:229-200-6524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health