Provider Demographics
NPI:1922629047
Name:INTERNATIONAL CENTER FOR INTEGRAL HEALTH AND EDUCATION
Entity Type:Organization
Organization Name:INTERNATIONAL CENTER FOR INTEGRAL HEALTH AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TEKLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC, BC-H
Authorized Official - Phone:800-659-1381
Mailing Address - Street 1:263 MIDTOWN DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5752
Mailing Address - Country:US
Mailing Address - Phone:231-642-9033
Mailing Address - Fax:231-642-9058
Practice Address - Street 1:263 MIDTOWN DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5752
Practice Address - Country:US
Practice Address - Phone:231-642-9033
Practice Address - Fax:231-642-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316429863OtherNPI NUMBER
MI1316429863Medicaid