Provider Demographics
NPI:1639816366
Name:INNER JOURNEY CONSULTING LLC
Entity Type:Organization
Organization Name:INNER JOURNEY CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:T
Authorized Official - Last Name:VITENSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-526-0982
Mailing Address - Street 1:1505 N. 60TH STREET
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2153
Mailing Address - Country:US
Mailing Address - Phone:414-526-0982
Mailing Address - Fax:
Practice Address - Street 1:1505 N. 60TH STREET
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53208-2153
Practice Address - Country:US
Practice Address - Phone:414-526-0982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty