Provider Demographics
NPI:1720835101
Name:INSPIRED LIFE BEHAVIORAL HEALTH & COUNSELING, NP, LLC
Entity type:Organization
Organization Name:INSPIRED LIFE BEHAVIORAL HEALTH & COUNSELING, NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:ANTANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:941-310-1863
Mailing Address - Street 1:1485 WASSAIL LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-6028
Mailing Address - Country:US
Mailing Address - Phone:941-310-1863
Mailing Address - Fax:
Practice Address - Street 1:1485 WASSAIL LN
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-6028
Practice Address - Country:US
Practice Address - Phone:941-310-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty