Provider Demographics
NPI:1619648375
Name:INNER ASCENT COUNSELING LLC
Entity Type:Organization
Organization Name:INNER ASCENT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-204-9095
Mailing Address - Street 1:11 E MARSHALL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 E MARSHALL ST STE 203
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1803
Practice Address - Country:US
Practice Address - Phone:715-204-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty