Provider Demographics
NPI:1336702273
Name:INTEGRATED CARE AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:INTEGRATED CARE AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-660-8627
Mailing Address - Street 1:4948 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8705
Mailing Address - Country:US
Mailing Address - Phone:605-306-3050
Mailing Address - Fax:
Practice Address - Street 1:4948 E 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8705
Practice Address - Country:US
Practice Address - Phone:605-306-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4744OtherLCSW-PIP