Basic Information
| Provider Information | |||||||||
| NPI: | 1639125206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSPIRA COUNSELING SERVICES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 367221 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009367221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877539515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 AVE HOSTOS | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009183014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877539515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CANDELARIO | ||||||||
| AuthorizedOfficialFirstName: | MYRNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877539515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 57025IN | 01 | PR | TRIPLE S INC PROVIDER | OTHER |