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General NPI Number Information
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NPI Number | 1881147999
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Entity Type | Organization
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Legal Business Name | INNER PEACE RESOLUTION, LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 6777 WOLF RUN LN
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City | N FORT MYERS
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State | FL
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Zip | 33917-3313
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Country | US
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Telephone | 239-785-8766
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Fax | 231-445-8835
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Provider Business Mailing Address
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Address Line | 5245 RAMSEY WAY SUITE #4
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City | FORT MYERS
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State | FL
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Zip | 33907-2124
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Country | US
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Telephone | 239-785-8766
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Fax | 231-445-8835
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | FELICITA ORTIZ
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Credential | LCSW
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Telephone | 239-785-8766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | SW7529
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License Number State | FL
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