Provider Demographics
NPI:1710447511
Name:INTEGRATIVE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:VESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-554-6028
Mailing Address - Street 1:1081 DOVE RUN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3678
Mailing Address - Country:US
Mailing Address - Phone:859-554-6028
Mailing Address - Fax:
Practice Address - Street 1:1081 DOVE RUN RD STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3678
Practice Address - Country:US
Practice Address - Phone:859-554-6028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty