Healthcare Provider Details

I. General information

NPI: 1134727274
Provider Name (Legal Business Name): INNER PEACE COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 E LAKE RD DEPT 280
PALM HARBOR FL
34685-2427
US

IV. Provider business mailing address

334 E LAKE RD DEPT 280
PALM HARBOR FL
34685-2427
US

V. Phone/Fax

Practice location:
  • Phone: 888-732-2313
  • Fax: 561-559-4005
Mailing address:
  • Phone: 888-732-2313
  • Fax: 727-274-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER M BONWIT
Title or Position: CEO, DIRECTOR
Credential:
Phone: 888-732-2313