Provider Demographics
NPI:1629789565
Name:INTEGRATED COUNSELING HEALTH SERVICES INC
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYANLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDIHOOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-479-2085
Mailing Address - Street 1:1250 MOORE LAKE DR E STE 212
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 MOORE LAKE DR E STE 212
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5136
Practice Address - Country:US
Practice Address - Phone:612-479-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center