Provider Demographics
NPI:1407444607
Name:INTEGRATED SELF COUNSELOR
Entity Type:Organization
Organization Name:INTEGRATED SELF COUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-588-3203
Mailing Address - Street 1:5200 N FLORA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5760
Mailing Address - Country:US
Mailing Address - Phone:816-588-3203
Mailing Address - Fax:
Practice Address - Street 1:5200 N FLORA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-5760
Practice Address - Country:US
Practice Address - Phone:816-588-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty