Provider Demographics
NPI:1720193899
Name:THE CENTER FOR INTEGRATIVE COUNSELING AND PSYCHOLOGY
Entity Type:Organization
Organization Name:THE CENTER FOR INTEGRATIVE COUNSELING AND PSYCHOLOGY
Other - Org Name:PASTORAL COUNSELING AND EDUCATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-526-4525
Mailing Address - Street 1:4305 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-6511
Mailing Address - Country:US
Mailing Address - Phone:214-526-4525
Mailing Address - Fax:214-520-6468
Practice Address - Street 1:4305 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6511
Practice Address - Country:US
Practice Address - Phone:214-526-4525
Practice Address - Fax:214-520-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L36LOtherBCBS
TX248265OtherMHN
TX291678000OtherMAGELLAN
TX083722101Medicaid
TX248265OtherMHN