1063798106 NPI number — WITHIN HOLISTIC COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063798106 NPI number — WITHIN HOLISTIC COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WITHIN HOLISTIC COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063798106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MIDLAKE DR STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37918-3089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-985-1084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 W JACKSON ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60098-3187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-297-5077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BALLARD
Authorized Official First Name:
CELESTE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
865-985-1084

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LCPC 180007509 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1447549555 . This is a "NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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