Provider Demographics
NPI:1932120029
Name:INNER RESOURCES INC.
Entity Type:Organization
Organization Name:INNER RESOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PAULY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-789-7100
Mailing Address - Street 1:12545 W BURLEIGH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3101
Mailing Address - Country:US
Mailing Address - Phone:262-789-7100
Mailing Address - Fax:
Practice Address - Street 1:12545 W BURLEIGH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3101
Practice Address - Country:US
Practice Address - Phone:262-789-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42188100Medicaid
WI000088102OtherMEDICARE PTAN