Provider Demographics
NPI:1417103912
Name:INNOVATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:INNOVATIVE COUNSELING SERVICES
Other - Org Name:JEAN POLLACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:888-821-2935
Mailing Address - Street 1:260 LYNBROOK DR N
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3228
Mailing Address - Country:US
Mailing Address - Phone:888-821-2935
Mailing Address - Fax:866-470-6121
Practice Address - Street 1:228 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2501
Practice Address - Country:US
Practice Address - Phone:888-821-2935
Practice Address - Fax:866-470-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSOO6977103T00000X
PAPS006977251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018496090001Medicaid