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General NPI Number Information
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NPI Number | 1992240139
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Entity Type | Organization
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Legal Business Name | INNER VISION COUNSELING
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Dates
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Enumeration Date | 12/26/2016
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Last Update Date | 12/26/2016
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Provider Practice Location Address
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Address Line | 17295 CHESTERFIELD AIRPORT RD
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1423
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Country | US
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Telephone | 636-530-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 17295 CHESTERFIELD AIRPORT RD STE 200
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1423
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Country | US
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Telephone | 636-530-3664
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. JOHNNETTA LYNN COLE
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Credential | LPC
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Telephone | 636-530-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2014007447
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License Number State | MO
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