Healthcare Provider Details

I. General information

NPI: 1043157258
Provider Name (Legal Business Name): INNER SPACE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10252 E 37TH PL
YUMA AZ
85365-7059
US

IV. Provider business mailing address

10252 E 37TH PL
YUMA AZ
85365-7059
US

V. Phone/Fax

Practice location:
  • Phone: 928-503-3628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: BRENDA LARA-SMITH
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 928-503-3628