Healthcare Provider Details

I. General information

NPI: 1346099553
Provider Name (Legal Business Name): INNER KNOWING THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 OLD CARRIAGE CT STE 200
SHAKOPEE MN
55379-3169
US

IV. Provider business mailing address

4525 PARK AVE
MINNEAPOLIS MN
55407-3541
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-9334
  • Fax: 612-520-5866
Mailing address:
  • Phone: 612-314-9334
  • Fax: 612-520-5866

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 State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE HILLER
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 612-314-9334