MEDICARE: INNER NOURISH 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	101YM0800X	Mental Health Counselor	0012939	CO

General Provider Information

NPI Number	:	1760837207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER NOURISH COUNSELING

Provider Business Mailing Address
First Line	:	9758 LAREDO ST
Second Line	:	8C
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9803
Country	:	US
Telephone Number	:	813-785-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	9758 LAREDO ST
Second Line	:	8C
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9803
Country	:	US
Telephone Number	:	813-785-9742
Fax Number	:

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	ISABEL PEREZ
Credential	:	LPC
Telephone Number	:	813-785-9742

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	11/01/2016

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