Provider Demographics
NPI:1790159093
Name:WITHINSIGHT COUNSELING AND HYPNOTHERAPY
Entity Type:Organization
Organization Name:WITHINSIGHT COUNSELING AND HYPNOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:734-678-5869
Mailing Address - Street 1:5807 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3206
Mailing Address - Country:US
Mailing Address - Phone:419-450-2170
Mailing Address - Fax:419-406-4590
Practice Address - Street 1:3950 SUNFOREST CT FL 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4485
Practice Address - Country:US
Practice Address - Phone:419-450-2170
Practice Address - Fax:419-406-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH#E3755101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309842Medicaid
OH1236565-0002OtherBWC
OH702401OtherAETNA