Provider Demographics
NPI:1023408622
Name:INNER RESOURCE PSYCHOTHERAPY
Entity type:Organization
Organization Name:INNER RESOURCE PSYCHOTHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGER/MEMBER & COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:OTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC
Authorized Official - Phone:904-310-4325
Mailing Address - Street 1:140 THE LAKES BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-5667
Mailing Address - Country:US
Mailing Address - Phone:904-310-4325
Mailing Address - Fax:904-895-6057
Practice Address - Street 1:140 THE LAKES BLVD STE 225
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5667
Practice Address - Country:US
Practice Address - Phone:904-310-4325
Practice Address - Fax:904-895-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YM0800X, 251S00000X
CT002098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty