1265752448 NPI number — INNER STRENGTH COUNSELING LLC

Table of content: BRYTNI NICOLE BOREL AUD. (NPI 1144588393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265752448 NPI number — INNER STRENGTH COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER STRENGTH COUNSELING LLC
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:
1265752448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33770-4605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-418-0735
Provider Business Mailing Address Fax Number:
866-706-0538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W BAY DR
Provider Second Line Business Practice Location Address:
SUITE 422
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-418-0735
Provider Business Practice Location Address Fax Number:
866-706-0538
Provider Enumeration Date:
06/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALEMI
Authorized Official First Name:
ELEANOR
Authorized Official Middle Name:
F
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
727-418-0735

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW9620 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12073150 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".