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General NPI Number Information
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NPI Number | 1528868478
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Entity Type | Organization
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Legal Business Name | INNER SPACE LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST STE 412
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City | SHREVEPORT
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State | LA
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Zip | 71105-2413
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Country | US
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Telephone | 318-295-0203
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 596
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City | PRINCETON
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State | LA
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Zip | 71067-0596
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. LANCE WHITE
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Credential | LPC
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Telephone | 318-295-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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