MEDICARE: THE INNER WISDOM

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	0011439	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35	OTHER	CO	PSYCHOTHERAPY

General Provider Information

NPI Number	:	1922421007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INNER WISDOM

Provider Business Mailing Address
First Line	:	1333 W 120TH AVE STE 218
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80234-2710
Country	:	US
Telephone Number	:	303-921-7261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 W 120TH AVE STE 218
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-2710
Country	:	US
Telephone Number	:	303-921-7261
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MRS. KRISTIN E LUKELA
Credential	:	LPC
Telephone Number	:	303-921-7261

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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Directions to “THE INNER WISDOM ” Practice Location

Language	Start Address	Practice Location

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