MEDICARE: INNER SPACE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043157258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER SPACE COUNSELING LLC

Provider Business Mailing Address
First Line	:	10252 E 37TH PL
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-7059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10252 E 37TH PL
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-7059
Country	:	US
Telephone Number	:	928-503-3628
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL COUNSELOR
Name	:	BRENDA LARA-SMITH
Credential	:	LPC
Telephone Number	:	928-503-3628

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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