Provider Demographics
NPI:1528493707
Name:INNERWISDOM
Entity type:Organization
Organization Name:INNERWISDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EMBRY
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-592-9292
Mailing Address - Street 1:13038 BAMBOO FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025
Mailing Address - Country:US
Mailing Address - Phone:713-592-9292
Mailing Address - Fax:713-933-2269
Practice Address - Street 1:13038 BAMBOO FOREST TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-592-9292
Practice Address - Fax:713-933-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52783302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization