Provider Demographics
NPI:1053833566
Name:INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-720-9782
Mailing Address - Street 1:9615 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1424
Mailing Address - Country:US
Mailing Address - Phone:1734-787-2183
Mailing Address - Fax:734-571-6888
Practice Address - Street 1:2955 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5231
Practice Address - Country:US
Practice Address - Phone:734-720-9782
Practice Address - Fax:734-571-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012410261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)