Provider Demographics
NPI:1013378108
Name:INNOVATIVE PSYCHOLOGY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE PSYCHOLOGY COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-508-2016
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-0541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4318 W CRYSTAL LAKE RD
Practice Address - Street 2:UNIT L
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4210
Practice Address - Country:US
Practice Address - Phone:847-508-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty