MEDICARE: INNERGLOW COUNSELING

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1356150759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERGLOW COUNSELING

Provider Business Mailing Address
First Line	:	8275 FILMORE CT
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-3569
Country	:	US
Telephone Number	:	248-762-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	8275 FILMORE CT
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-3569
Country	:	US
Telephone Number	:	248-762-6423
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARCY RENEE KOLB
Credential	:	LMSW
Telephone Number	:	248-762-6423

Provider Enumeration Date	:	01/01/2025
Last Update Date	:	01/01/2025

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Directions to “INNERGLOW COUNSELING ” Practice Location

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