Provider Demographics
NPI:1235234733
Name:INTEGRATIVE COUNSELING & PSYCHOLOGICAL SERVICES,PC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING & PSYCHOLOGICAL SERVICES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DERENGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-920-4076
Mailing Address - Street 1:3925 75TH ST
Mailing Address - Street 2:SUITE105
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7913
Mailing Address - Country:US
Mailing Address - Phone:630-701-1117
Mailing Address - Fax:630-983-1914
Practice Address - Street 1:3925 75TH ST
Practice Address - Street 2:SUITE105
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7913
Practice Address - Country:US
Practice Address - Phone:630-701-1117
Practice Address - Fax:630-983-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232380OtherBCBS PROVIDER #
IL02232380OtherBCBS PROVIDER #