Provider Demographics
NPI:1508486473
Name:INTEGRATIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:FOLSOM
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:801-793-0620
Mailing Address - Street 1:510 E SEGO LILY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3546
Mailing Address - Country:US
Mailing Address - Phone:801-793-0620
Mailing Address - Fax:844-440-5778
Practice Address - Street 1:510 E SEGO LILY DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3546
Practice Address - Country:US
Practice Address - Phone:801-793-0620
Practice Address - Fax:844-440-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5828209-6004OtherLCMHC