| Inner Light Therapy Center Llc | |
|
850 Kaliste Saloom Rd Bldg Suite116 Lafayette LA 70508-4230 | |
| (337) 247-4370 | |
| Not Available |
| Full Name | Inner Light Therapy Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 850 Kaliste Saloom Rd Bldg Suite116, Lafayette, Louisiana |
| Authorized Official Name and Position | Jayme Liles (OWNER) |
| Authorized Official Contact | 3372474370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inner Light Therapy Center Llc 502 Woodvale Ave Lafayette LA 70503-3436 Ph: (337) 247-4370 | Inner Light Therapy Center Llc 850 Kaliste Saloom Rd Bldg Suite116 Lafayette LA 70508-4230 Ph: (337) 247-4370 |
| NPI Number | 1386292019 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 08/16/2022 |
| Certification Date | 08/16/2022 |
| Medicare PECOS PAC ID | 2365773538 |
|---|---|
| Medicare Enrollment ID | O20191021000364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386292019 | NPI | - | NPPES |
| 2514644 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jayme Ann Liles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871141663 PECOS PAC ID: 3274864442 Enrollment ID: I20191021000398 |
| Provider Name | Devin Paul Dupre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578234878 PECOS PAC ID: 8022416189 Enrollment ID: I20211005000963 |
| Provider Name | Mandy Alecia Mccoy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629647102 PECOS PAC ID: 7315302957 Enrollment ID: I20230522000554 |
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