Healthcare Provider Details

I. General information

NPI: 1821779562
Provider Name (Legal Business Name): INNER REALMS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7490 S PLEASANTVIEW RD
HARBOR SPRINGS MI
49740-9422
US

IV. Provider business mailing address

PO BOX 2385
PETOSKEY MI
49770-1885
US

V. Phone/Fax

Practice location:
  • Phone: 231-838-7837
  • Fax:
Mailing address:
  • Phone: 231-838-7837
  • Fax:

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD D ALEXANDER
Title or Position: MEMBER
Credential: MA, LPC
Phone: 231-838-7837