NPIMap

Organization Active NPI

Innerspace Center for Emotional Health LLC

Doing business as Innerspace Center for Emotional Health

  • Mental Health Counselor
  • Evansville, IN
National Provider Identifier
1891356119
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INNERSPACE CENTER FOR EMOTIONAL HEALTH LLC
Doing business as
Innerspace Center for Emotional Health
Practice address
101 Plaza East Blvd Ste 224
Evansville, IN 47715-2806
Phone
(812) 773-8289
Fax
(812) 308-4064
NPI assigned
Jun 26, 2019
Last updated
Aug 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Authorized official

Name
Bonnie J Hertaus, LCSW
Title
Tin Owner
Phone
(812) 772-8289

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

101 Plaza East Blvd Ste 224
Evansville, IN 47715-2806

Mailing address

101 Plaza East Blvd Ste 224
Evansville, IN 47715-2806
Phone (812) 773-8289

Other names 1

  • INNERSPACE CENTER FOR EMOTIONAL HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190816001011 IN Part B Supplier - Clinic/Group Practice 8820325681 Receives reassigned benefits from 10 practitioners
Practice locations: Evansville, IN

National Provider Directory

National Provider Directory

Locations

101 N Plaza East Blvd
Ste 230
Evansville, IN 47715
Phone (812) 413-0315

Practitioners & affiliated clinicians

Practitioners 11

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": "1561507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1891356119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PLAZA EAST BLVD STE 224",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152806",
            "telephone_number": "812-773-8289",
            "fax_number": "812-308-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PLAZA EAST BLVD STE 224",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152806",
            "telephone_number": "812-773-8289",
            "fax_number": "812-308-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERSPACE CENTER FOR EMOTIONAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-26",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "HERTAUS",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TIN OWNER",
        "authorized_official_telephone_number": "812-772-8289",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INNERSPACE CENTER FOR EMOTIONAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "INNERSPACE CENTER FOR EMOTIONAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; 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.