MEDICARE: INNER PEACE COUNSELING & WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	102L00000X	Psychoanalyst
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134727274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER PEACE COUNSELING & WELLNESS

Provider Business Mailing Address
First Line	:	334 E LAKE RD DEPT 280
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	888-732-2313
Fax Number	:	727-274-1714

Provider Business Practice Location Address
First Line	:	334 E LAKE RD DEPT 280
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2427
Country	:	US
Telephone Number	:	888-732-2313
Fax Number	:	561-559-4005

Authorized Official
Title or Position	:	CEO, DIRECTOR
Name	:	MR. TYLER M BONWIT
Credential	:
Telephone Number	:	888-732-2313

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	03/06/2021

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