MEDICARE: THE INNER MIND 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1801759451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INNER MIND LLC

Provider Business Mailing Address
First Line	:	7444 HACKBERRY RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-4588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7444 HACKBERRY RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-4588
Country	:	US
Telephone Number	:	281-503-1553
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDRANIQUE L GOODMAN
Credential	:
Telephone Number	:	281-503-1553

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “THE INNER MIND LLC ” Practice Location

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