Provider Demographics
NPI:1427214899
Name:INNERLIGHT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INNERLIGHT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERGFELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW
Authorized Official - Phone:810-630-0904
Mailing Address - Street 1:6199 MILLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1585
Mailing Address - Country:US
Mailing Address - Phone:810-630-0904
Mailing Address - Fax:810-630-0962
Practice Address - Street 1:6199 MILLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1585
Practice Address - Country:US
Practice Address - Phone:810-630-0904
Practice Address - Fax:810-630-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010612441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION83360Medicare UPIN