Provider Demographics
NPI:1124708912
Name:INNERESILIENCE GYM, PLLC
Entity type:Organization
Organization Name:INNERESILIENCE GYM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:877-765-9694
Mailing Address - Street 1:22019 GOLDEN CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4647
Mailing Address - Country:US
Mailing Address - Phone:917-651-6474
Mailing Address - Fax:
Practice Address - Street 1:22019 GOLDEN CEDAR DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4647
Practice Address - Country:US
Practice Address - Phone:917-651-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)