| Innerlight Wellness Counseling Pllc | |
|
119c Griswold St Ste 202 Glastonbury CT 06033-1099 | |
| (860) 918-7946 | |
| (860) 735-5842 |
| Full Name | Innerlight Wellness Counseling Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 119c Griswold St Ste 202, Glastonbury, Connecticut |
| Authorized Official Name and Position | Mandy L Tiedeman (MEMBER) |
| Authorized Official Contact | 8609187946 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innerlight Wellness Counseling Pllc 119c Griswold St Ste 202 Glastonbury CT 06033-1099 Ph: (860) 918-7946 | Innerlight Wellness Counseling Pllc 119c Griswold St Ste 202 Glastonbury CT 06033-1099 Ph: (860) 918-7946 |
| NPI Number | 1043094956 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 08/22/2023 |
| Certification Date | 08/22/2023 |
| Medicare PECOS PAC ID | 8921446550 |
|---|---|
| Medicare Enrollment ID | O20240402002458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043094956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Mandy L Tiedeman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891300539 PECOS PAC ID: 9830537463 Enrollment ID: I20240402002553 |
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