MEDICARE: INNER PEACE COUNSELING AND WELLNESS 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932880655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER PEACE COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	541 HIGHLANDVIEW DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-3817
Country	:	US
Telephone Number	:	920-252-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 WALNUT ST STE 2
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-3331
Country	:	US
Telephone Number	:	920-252-2297
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	CAITLIN YOGERST
Credential	:	LPC
Telephone Number	:	920-252-2297

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	10/06/2023

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