MEDICARE: INNER ESSENCE THERAPY, CONSULTING AND DIAGNOSTIC PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891393542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER ESSENCE THERAPY, CONSULTING AND DIAGNOSTIC PLLC

Provider Business Mailing Address
First Line	:	10800 GOSLING RD UNIT 130142
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-4008
Country	:	US
Telephone Number	:	510-686-3446
Fax Number	:	832-202-1360

Provider Business Practice Location Address
First Line	:	10800 GOSLING RD UNIT 130142
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-4008
Country	:	US
Telephone Number	:	510-686-3446
Fax Number	:	832-202-1360

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	ALISA ZACHERY
Credential	:	LCSW
Telephone Number	:	510-686-3446

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/06/2021

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