Provider Demographics
NPI:1922421007
Name:THE INNER WISDOM
Entity Type:Organization
Organization Name:THE INNER WISDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUKELA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-921-7261
Mailing Address - Street 1:1333 W 120TH AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2710
Mailing Address - Country:US
Mailing Address - Phone:303-921-7261
Mailing Address - Fax:
Practice Address - Street 1:1333 W 120TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2710
Practice Address - Country:US
Practice Address - Phone:303-921-7261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35OtherPSYCHOTHERAPY