| Innerspace Center For Emotional Health | |
|
101 Plaza East Blvd Ste 224 Evansville IN 47715-2806 | |
| (812) 773-8289 | |
| (812) 308-4064 |
| Full Name | Innerspace Center For Emotional Health |
|---|---|
| Speciality | Counselor |
| Location | 101 Plaza East Blvd Ste 224, Evansville, Indiana |
| Authorized Official Name and Position | Bonnie J Hertaus (TIN OWNER) |
| Authorized Official Contact | 8127728289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innerspace Center For Emotional Health 101 Plaza East Blvd Ste 224 Evansville IN 47715-2806 Ph: (812) 773-8289 | Innerspace Center For Emotional Health 101 Plaza East Blvd Ste 224 Evansville IN 47715-2806 Ph: (812) 773-8289 |
| NPI Number | 1891356119 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 08/02/2019 |
| Medicare PECOS PAC ID | 8820325681 |
|---|---|
| Medicare Enrollment ID | O20190816001011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891356119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Bonnie Jordan Ames |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609382761 PECOS PAC ID: 6608119854 Enrollment ID: I20190510001074 |
| Provider Name | Thea Luigs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669961256 PECOS PAC ID: 6800206780 Enrollment ID: I20201104000816 |
| Provider Name | Michael Crowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396193835 PECOS PAC ID: 6103220819 Enrollment ID: I20210803001115 |
| Provider Name | Kalyn Goodwin-shelton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649992496 PECOS PAC ID: 8426424912 Enrollment ID: I20221025002420 |
| Provider Name | Adria Marie Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831688464 PECOS PAC ID: 5799158341 Enrollment ID: I20230301000441 |
| Provider Name | Heather Meredith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407506009 PECOS PAC ID: 5294197059 Enrollment ID: I20230811000490 |
| Provider Name | Payton L Cox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336913086 PECOS PAC ID: 6002264983 Enrollment ID: I20231204000963 |
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