Healthcare Provider Details

I. General information

NPI: 1831917343
Provider Name (Legal Business Name): INNER HARMONY PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW 43RD ST STE E2
GAINESVILLE FL
32606-8134
US

IV. Provider business mailing address

806 NW 16TH AVE UNIT 172
GAINESVILLE FL
32601-4012
US

V. Phone/Fax

Practice location:
  • Phone: 352-448-8531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KELSEA VISALLI-BETTAG
Title or Position: OWNER, PSYCHOLOGIST
Credential: PH.D.
Phone: 260-249-7505