Provider Demographics
NPI:1457007767
Name:INTEGRATIVE CARE PRACTITIONERS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CARE PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-201-4808
Mailing Address - Street 1:109 ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:PORTERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16051
Mailing Address - Country:US
Mailing Address - Phone:724-201-4808
Mailing Address - Fax:724-220-4505
Practice Address - Street 1:109 ADAMS LN
Practice Address - Street 2:
Practice Address - City:PORTERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16051
Practice Address - Country:US
Practice Address - Phone:724-201-4808
Practice Address - Fax:724-220-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty