Provider Demographics
NPI:1598939274
Name:INTEGRATIVE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:1800-499-4169
Mailing Address - Street 1:19900 E 10 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-4412
Mailing Address - Country:US
Mailing Address - Phone:586-491-2040
Mailing Address - Fax:
Practice Address - Street 1:19900 E 10 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-4412
Practice Address - Country:US
Practice Address - Phone:586-491-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty