MEDICARE: INNER LIGHT COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114552692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER LIGHT COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	4195 CASTLE AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2309
Country	:	US
Telephone Number	:	727-773-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4195 CASTLE AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2309
Country	:	US
Telephone Number	:	727-773-7804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PENELOPE J HAZINAKIS-SWAINSTON
Credential	:	LMHC
Telephone Number	:	727-698-3804

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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