NPIMap

Organization Active NPI

Innerlight Wellness, LLC

  • Professional Counselor
  • Shreveport, LA
National Provider Identifier
1730536202
Registry record updated May 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3699 Issued in LA
Legal business name
INNERLIGHT WELLNESS, LLC
Practice address
820 Jordan St
Suite 204
Shreveport, LA 71101-4518
Phone
(318) 267-0757
Fax
(318) 670-7232
NPI assigned
May 15, 2016
Last updated
May 15, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2016

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

Authorized official

Name
Ms. Nancy Booker Tracy, MS, LPCNPI 1356641625
Title
Owner
Phone
(318) 268-0757

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X 3699 LA Primary

Addresses

Primary practice location

820 Jordan St
Suite 204
Shreveport, LA 71101-4518

Mailing address

1113 Drew LN
Minden, LA 71055-2301
Phone (318) 268-0757

Other identifiers 1

IdentifierTypeStateIssuer
2185942MedicaidLA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1463270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463270400000",
    "number": "1730536202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 DREW LN",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710552301",
            "telephone_number": "318-268-0757",
            "fax_number": "318-670-7232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 JORDAN ST",
            "address_2": "SUITE 204",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014518",
            "telephone_number": "318-267-0757",
            "fax_number": "318-670-7232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERLIGHT WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-15",
        "last_updated": "2016-05-15",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "BOOKER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-268-0757",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "3699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2185942",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2016; 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.