Provider Demographics
NPI:1427563907
Name:INNER LIFE OUTSIDE WORLD
Entity type:Organization
Organization Name:INNER LIFE OUTSIDE WORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-210-9290
Mailing Address - Street 1:1522 VILLANOVA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7838
Mailing Address - Country:US
Mailing Address - Phone:512-210-9290
Mailing Address - Fax:
Practice Address - Street 1:1522 VILLANOVA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7838
Practice Address - Country:US
Practice Address - Phone:512-210-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty