Healthcare Provider Details

I. General information

NPI: 1558837161
Provider Name (Legal Business Name): INSIDE OUT YOUR VOICE YOUR STORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 WINEGARD RD
ORLANDO FL
32809-7147
US

IV. Provider business mailing address

7726 WINEGARD RD
ORLANDO FL
32809-7147
US

V. Phone/Fax

Practice location:
  • Phone: 844-711-8336
  • Fax:
Mailing address:
  • Phone: 844-711-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONIQUE PENA
Title or Position: MSW
Credential:
Phone: 219-552-8336