Provider Demographics
NPI:1801487574
Name:INSPIRED PEACE COUNSELING SERVICES
Entity type:Organization
Organization Name:INSPIRED PEACE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-613-7872
Mailing Address - Street 1:3009 WINTER GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7140
Mailing Address - Country:US
Mailing Address - Phone:219-508-5646
Mailing Address - Fax:
Practice Address - Street 1:3009 WINTER GARDEN DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-7140
Practice Address - Country:US
Practice Address - Phone:219-508-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801487574OtherBUSINESS NPI
IN1891382339OtherPROVIDER NPI
IN300067700Medicaid