Inner Balance Psychotherapy Services LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INNER BALANCE PSYCHOTHERAPY SERVICES LLC

Practice address

208 E 2ND North St
Summerville, SC 29483-2157

Phone

(785) 236-9196

NPI assigned

May 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marisa SisselNPI 1912191578

Title

Provider/Owner

Phone

(785) 236-9196

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marisa Christina Elena Sissel, LISW-CP

  • Clinical Social Worker
  • Goose Creek, SC
  • NPI 1912191578
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1376390880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 E 2ND NORTH ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294832157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E 2ND NORTH ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294832157",
            "telephone_number": "785-236-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER BALANCE PSYCHOTHERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "SISSEL",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "785-236-9196"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Summerville, SC
• Providers in Summerville, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.