Healthcare Provider Details

I. General information

NPI: 1023408622
Provider Name (Legal Business Name): INNER RESOURCE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 THE LAKES BLVD STE 225
KINGSLAND GA
31548-5667
US

IV. Provider business mailing address

140 THE LAKES BLVD STE 225
KINGSLAND GA
31548-5667
US

V. Phone/Fax

Practice location:
  • Phone: 904-310-4325
  • Fax: 904-895-6057
Mailing address:
  • Phone: 904-310-4325
  • Fax: 904-895-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002098
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY BETH OTZEL
Title or Position: SOLE MANAGER/MEMBER & COUNSELOR
Credential: LPC, LMHC
Phone: 904-310-4325