Healthcare Provider Details

I. General information

NPI: 1003700584
Provider Name (Legal Business Name): INNER PRISM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 WEST ST
PITTSBURGH PA
15221-2838
US

IV. Provider business mailing address

206 PHILLIPS DR
PITTSBURGH PA
15241-1320
US

V. Phone/Fax

Practice location:
  • Phone: 412-528-6778
  • Fax: 412-240-4658
Mailing address:
  • Phone: 412-528-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GWENDOLYN KELLY
Title or Position: PRACTICE OWNER/THERAPIST
Credential: LSW
Phone: 412-528-6778