MEDICARE: INNER HOPE THERAPY

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	:	1972166080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER HOPE THERAPY

Provider Business Mailing Address
First Line	:	1102 TULIP PL
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80907-3709
Country	:	US
Telephone Number	:	719-440-8361
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 N. ACADEMY BLVD. SUITE 206
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-8091
Country	:	US
Telephone Number	:	719-440-8361
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	LISA JOHNSON
Credential	:	LPC
Telephone Number	:	719-440-8361

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	04/16/2019

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Directions to “INNER HOPE THERAPY ” Practice Location

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