| Inner Space Llc | |
|
2924 Knight St Ste 412 Shreveport LA 71105-2413 | |
| (318) 295-0203 | |
| Not Available |
| Full Name | Inner Space Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2924 Knight St Ste 412, Shreveport, Louisiana |
| Authorized Official Name and Position | Lance White (COUNSELOR) |
| Authorized Official Contact | 3182950203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Space Llc Po Box 596 Princeton LA 71067-0596 Ph: () - | Inner Space Llc 2924 Knight St Ste 412 Shreveport LA 71105-2413 Ph: (318) 295-0203 |
| NPI Number | 1528868478 |
|---|---|
| Provider Enumeration Date | 03/18/2025 |
| Last Update Date | 03/21/2025 |
| Certification Date | 03/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528868478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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