1689726499 NPI number — INNER PEACE COUNSELING, INC

Table of content: (NPI 1689726499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689726499 NPI number — INNER PEACE COUNSELING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNER PEACE COUNSELING, INC
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:
1689726499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N MARKET BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-2666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-748-7268
Provider Business Mailing Address Fax Number:
360-740-9787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 N MARKET BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-2666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-748-7268
Provider Business Practice Location Address Fax Number:
360-740-9787
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEIM
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER, ADMINISTRATOR, PROVIDER
Authorized Official Telephone Number:
360-748-7268

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  21054900 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CP00005966 . This is a "CHEMICAL DEPENDENCY PROFE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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