Provider Demographics
NPI:1538445549
Name:INNERSIGHT COUNSELING PROFESSIONALS LLC
Entity type:Organization
Organization Name:INNERSIGHT COUNSELING PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC-S, CDCA
Authorized Official - Phone:937-426-2113
Mailing Address - Street 1:P.O. BOX 383
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7905 SCHATZ POINTE DR STE 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-0001
Practice Address - Country:US
Practice Address - Phone:937-426-2113
Practice Address - Fax:937-426-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty