MEDICARE: INNER LIFE OUTSIDE WORLD

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	101YP2500X	Professional Counselor	72767	TX

General Provider Information

NPI Number	:	1427563907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER LIFE OUTSIDE WORLD

Provider Business Mailing Address
First Line	:	1522 VILLANOVA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7838
Country	:	US
Telephone Number	:	512-210-9290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 VILLANOVA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7838
Country	:	US
Telephone Number	:	512-210-9290
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	SHOSHANNA M. WILLNER
Credential	:	LPC
Telephone Number	:	512-210-9290

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	06/16/2018

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Directions to “INNER LIFE OUTSIDE WORLD ” Practice Location

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