Provider Demographics
NPI:1275025314
Name:INTEGRATIVE MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MENTAL HEALTH SERVICES LLC
Other - Org Name:INTEGRATIVE COUNSELING CENTER (ICC)
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LPC
Authorized Official - Phone:773-706-8981
Mailing Address - Street 1:6730 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3941
Mailing Address - Country:US
Mailing Address - Phone:480-216-3276
Mailing Address - Fax:
Practice Address - Street 1:11811 N TATUM BLVD STE 3031
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1621
Practice Address - Country:US
Practice Address - Phone:773-706-8981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
180.010511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty