Provider Demographics
NPI:1437208493
Name:INNERQUEST LLC
Entity Type:Organization
Organization Name:INNERQUEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-650-6241
Mailing Address - Street 1:12600 N 113TH AVE STE C19
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1125
Mailing Address - Country:US
Mailing Address - Phone:480-650-6241
Mailing Address - Fax:
Practice Address - Street 1:12600 N 113TH AVE STE C19
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1125
Practice Address - Country:US
Practice Address - Phone:480-650-6241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty