| Inner Sanctum Counseling Llc | |
|
909 Linway Dr Ste 3 Goshen IN 46526-2435 | |
| (574) 285-2078 | |
| Not Available |
| Full Name | Inner Sanctum Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 909 Linway Dr Ste 3, Goshen, Indiana |
| Authorized Official Name and Position | Timothy Lagro (OWNER) |
| Authorized Official Contact | 6144677481 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Sanctum Counseling Llc 909 Linway Dr Ste 3 Goshen IN 46526-2435 Ph: (574) 285-2078 | Inner Sanctum Counseling Llc 909 Linway Dr Ste 3 Goshen IN 46526-2435 Ph: (574) 285-2078 |
| NPI Number | 1316777964 |
|---|---|
| Provider Enumeration Date | 08/07/2024 |
| Last Update Date | 08/07/2024 |
| Certification Date | 08/07/2024 |
| Medicare PECOS PAC ID | 5395279806 |
|---|---|
| Medicare Enrollment ID | O20241106002681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316777964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Timothy Lagro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609124684 PECOS PAC ID: 8022542547 Enrollment ID: I20241106002872 |
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