Provider Demographics
NPI:1336875152
Name:INNER LIFE COUNSELING
Entity Type:Organization
Organization Name:INNER LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-706-1141
Mailing Address - Street 1:1601 GREENBRIAR PL STE 1
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7642
Mailing Address - Country:US
Mailing Address - Phone:405-706-1141
Mailing Address - Fax:405-237-3786
Practice Address - Street 1:1601 GREENBRIAR PL STE 1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7642
Practice Address - Country:US
Practice Address - Phone:405-706-1141
Practice Address - Fax:405-237-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty