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General NPI Number Information
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NPI Number | 1609601400
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Entity Type | Organization
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Legal Business Name | INNERSPACE PROFESSIONAL COUNSELING
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 5605 FINCH DR APT 215
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City | LONGVIEW
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State | WA
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Zip | 98632-9244
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Country | US
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Telephone | 479-244-0453
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Fax |
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Provider Business Mailing Address
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Address Line | 600 1ST AVE STE 102
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City | SEATTLE
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State | WA
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Zip | 98104-2287
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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 | OWNER
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Name | SARA SMITH
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Credential |
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Telephone | 479-244-0453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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