Provider Demographics
NPI:1992240139
Name:INNER VISION COUNSELING
Entity type:Organization
Organization Name:INNER VISION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHNNETTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-530-3664
Mailing Address - Street 1:17295 CHESTERFIELD AIRPORT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1423
Mailing Address - Country:US
Mailing Address - Phone:636-530-3664
Mailing Address - Fax:
Practice Address - Street 1:17295 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1423
Practice Address - Country:US
Practice Address - Phone:636-530-3664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014007447101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty