Provider Demographics
NPI:1356059125
Name:INNER LIGHT THERAPY LLC
Entity type:Organization
Organization Name:INNER LIGHT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:907-205-7887
Mailing Address - Street 1:1131 E 76TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3209
Mailing Address - Country:US
Mailing Address - Phone:907-205-7887
Mailing Address - Fax:907-206-7203
Practice Address - Street 1:1131 E 76TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3209
Practice Address - Country:US
Practice Address - Phone:907-205-7887
Practice Address - Fax:907-206-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK185850OtherSTATE OF ALASKA, PROFESSIONAL LICENSING DIVISION