MEDICARE: WITHINSIGHT COUNSELING AND HYPNOTHERAPY

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	101Y00000X	Counselor	#E3755	OH
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1236565-0002	OTHER	OH	BWC
3	702401	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1790159093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITHINSIGHT COUNSELING AND HYPNOTHERAPY

Provider Business Mailing Address
First Line	:	5807 HAMPSHIRE LN
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-3206
Country	:	US
Telephone Number	:	419-450-2170
Fax Number	:	419-406-4590

Provider Business Practice Location Address
First Line	:	3950 SUNFOREST CT FL 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4485
Country	:	US
Telephone Number	:	419-450-2170
Fax Number	:	419-406-4590

Authorized Official
Title or Position	:	OWNER
Name	:	VIKKI RENEE GARDNER
Credential	:	LPCC-S
Telephone Number	:	734-678-5869

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	12/20/2023

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