Provider Demographics
NPI:1437582566
Name:INTEGRATED COUNSELING SERVICES
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:COLLETTE
Authorized Official - Last Name:FOLLINGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:218-731-2320
Mailing Address - Street 1:1132 28TH AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4420
Mailing Address - Country:US
Mailing Address - Phone:218-731-2320
Mailing Address - Fax:218-867-3712
Practice Address - Street 1:1132 28TH AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4420
Practice Address - Country:US
Practice Address - Phone:218-731-2320
Practice Address - Fax:218-867-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4052251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN668524200Medicaid