Provider Demographics
NPI:1881147999
Name:INNER PEACE RESOLUTION, LLC
Entity type:Organization
Organization Name:INNER PEACE RESOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FELICITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-785-8766
Mailing Address - Street 1:5245 RAMSEY WAY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2124
Mailing Address - Country:US
Mailing Address - Phone:239-785-8766
Mailing Address - Fax:231-445-8835
Practice Address - Street 1:6777 WOLF RUN LN
Practice Address - Street 2:
Practice Address - City:N FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3313
Practice Address - Country:US
Practice Address - Phone:239-785-8766
Practice Address - Fax:231-445-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7529103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty