Provider Demographics
NPI:1083350318
Name:INNER CONNECTIONS LLC
Entity Type:Organization
Organization Name:INNER CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PRUDENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-517-0244
Mailing Address - Street 1:S5320 COOK HILL RD
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-7133
Mailing Address - Country:US
Mailing Address - Phone:608-606-6829
Mailing Address - Fax:
Practice Address - Street 1:S5320 COOK HILL RD
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-7133
Practice Address - Country:US
Practice Address - Phone:608-606-6829
Practice Address - Fax:608-999-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty