Provider Demographics
NPI:1376384412
Name:INNER VOYAGE MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:INNER VOYAGE MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:UNDERDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:952-261-6131
Mailing Address - Street 1:13 TURNER PL UNIT 333
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-4168
Mailing Address - Country:US
Mailing Address - Phone:952-261-6131
Mailing Address - Fax:
Practice Address - Street 1:13 TURNER PL UNIT 333
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748-4168
Practice Address - Country:US
Practice Address - Phone:952-261-6131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health