MEDICARE: INNER PEACE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558973560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER PEACE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1130 LONDONERRY LN
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1632
Country	:	US
Telephone Number	:	812-568-5267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 LONDONERRY LN
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1632
Country	:	US
Telephone Number	:	812-568-5267
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORY BUCHANAN
Credential	:	LCSW
Telephone Number	:	812-568-5267

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	03/14/2021

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