Provider Demographics
NPI:1437515160
Name:INNER WISDOM THERAPY AND HEALING ARTS, LLC
Entity Type:Organization
Organization Name:INNER WISDOM THERAPY AND HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVOLISKY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:541-948-9243
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0973
Mailing Address - Country:US
Mailing Address - Phone:541-948-9243
Mailing Address - Fax:541-631-2599
Practice Address - Street 1:420 WILLIAMSON WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1251
Practice Address - Country:US
Practice Address - Phone:541-948-9243
Practice Address - Fax:541-631-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty