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General NPI Number Information
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NPI Number | 1396884011
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Entity Type | Organization
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Legal Business Name | INNERLIGHT, INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8089 S LINCOLN ST SUITE 203
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City | LITTLETON
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State | CO
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Zip | 80122-2700
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Country | US
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Telephone | 303-915-5567
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Fax |
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Provider Business Mailing Address
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Address Line | 8089 S LINCOLN ST SUITE 203
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City | LITTLETON
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State | CO
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Zip | 80122-2700
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Country | US
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Telephone | 303-915-5567
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOTHERAPIST
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Name | MS. DERICA WALLER
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Credential | LCSW
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Telephone | 303-915-5567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 83
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License Number State | CO
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