Inside Out Relationship Makeover Services, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

INSIDE OUT RELATIONSHIP MAKEOVER SERVICES, LLC

Practice address

1954 Airport Rd # 1643
Atlanta, GA 30341-4956

Phone

(630) 272-1897

NPI assigned

May 19, 2023

Last updated

May 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shavonna Nicole Peterson, LPCNPI 1629733597

Title

Owner/Therapist/Ceo

Phone

(630) 272-1897

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shavonna Peterson

  • Mental Health Counselor
  • Aurora, IL
  • NPI 1629733597
  NPD Authorized official

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1588355432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 AIRPORT RD # 1643",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1954 AIRPORT RD # 1643",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303414956",
            "telephone_number": "630-272-1897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSIDE OUT RELATIONSHIP MAKEOVER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SHAVONNA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER/THERAPIST/CEO",
        "authorized_official_telephone_number": "630-272-1897",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Adult Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.