Provider Demographics
NPI:1376153106
Name:INTEGRATIVE COUNSELING PRACTICES
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING PRACTICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:STORK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:712-790-9318
Mailing Address - Street 1:3662 GARBER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-7554
Mailing Address - Country:US
Mailing Address - Phone:712-790-9318
Mailing Address - Fax:
Practice Address - Street 1:1728 CENTRAL AVE STE 10
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:712-790-9318
Practice Address - Fax:515-598-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty