Provider Demographics
NPI:1083661334
Name:INNOVATIVE COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:INNOVATIVE COUNSELING SERVICES, INC
Other - Org Name:CYNTHIA M. EISENBEIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EISENBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:314-484-6198
Mailing Address - Street 1:621 BULL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8544
Mailing Address - Country:US
Mailing Address - Phone:314-484-6198
Mailing Address - Fax:
Practice Address - Street 1:1137 N MAIN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1217
Practice Address - Country:US
Practice Address - Phone:314-484-6198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050400101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty