Provider Demographics
NPI:1063901833
Name:INNERESSENCE COUNSELING AND CLINICAL HYPNOTHERAPY
Entity type:Organization
Organization Name:INNERESSENCE COUNSELING AND CLINICAL HYPNOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CHT
Authorized Official - Phone:248-827-5583
Mailing Address - Street 1:18465 SOUTH DR APT 173
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1133
Mailing Address - Country:US
Mailing Address - Phone:248-470-9959
Mailing Address - Fax:
Practice Address - Street 1:380 N OLD WOODWARD AVE STE 156
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5307
Practice Address - Country:US
Practice Address - Phone:248-827-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty