MEDICARE: INNERLIGHT COUNSELING SERVICES 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	1041C0700X	Clinical Social Worker	6801061244	MI

General Provider Information

NPI Number	:	1427214899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERLIGHT COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	6199 MILLER RD
Second Line	:	SUITE A
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1585
Country	:	US
Telephone Number	:	810-630-0904
Fax Number	:	810-630-0962

Provider Business Practice Location Address
First Line	:	6199 MILLER RD
Second Line	:	SUITE A
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1585
Country	:	US
Telephone Number	:	810-630-0904
Fax Number	:	810-630-0962

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. SANDRA MARIE BERGFELD
Credential	:	LMSW ACSW
Telephone Number	:	810-630-0904

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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