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General NPI Number Information
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NPI Number | 1831917343
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Entity Type | Organization
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Legal Business Name | INNER HARMONY PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 3600 NW 43RD ST STE E2
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City | GAINESVILLE
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State | FL
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Zip | 32606-8134
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Country | US
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Telephone | 352-448-8531
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Fax |
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Provider Business Mailing Address
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Address Line | 806 NW 16TH AVE UNIT 172
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City | GAINESVILLE
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State | FL
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Zip | 32601-4012
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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, PSYCHOLOGIST
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Name | KELSEA VISALLI-BETTAG
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Credential | PH.D.
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Telephone | 260-249-7505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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