Provider Demographics
NPI:1346446937
Name:INTEGRATED COUNSELING CENTER
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:HOA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW
Authorized Official - Phone:712-530-5360
Mailing Address - Street 1:12900B GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE #145
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2018
Mailing Address - Country:US
Mailing Address - Phone:714-530-5360
Mailing Address - Fax:714-530-5565
Practice Address - Street 1:12900B GARDEN GROVE BLVD
Practice Address - Street 2:SUITE #145
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2018
Practice Address - Country:US
Practice Address - Phone:714-530-5360
Practice Address - Fax:714-530-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 193151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty