| Intentional Living, Llc | |
|
16308 Elkhorn Ln Bowie MD 20716-3259 | |
| (301) 659-6162 | |
| (443) 331-4441 |
| Full Name | Intentional Living, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 16308 Elkhorn Ln, Bowie, Maryland |
| Authorized Official Name and Position | Krystle Tinsley (OWNER) |
| Authorized Official Contact | 3016596162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Living, Llc 16308 Elkhorn Ln Bowie MD 20716-3259 Ph: (301) 659-6162 | Intentional Living, Llc 16308 Elkhorn Ln Bowie MD 20716-3259 Ph: (301) 659-6162 |
| NPI Number | 1568240604 |
|---|---|
| Provider Enumeration Date | 09/19/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 7315393923 |
|---|---|
| Medicare Enrollment ID | O20231101003472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568240604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Krystle Linnette Tinsley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003321779 PECOS PAC ID: 8224484837 Enrollment ID: I20231101003516 |
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