Provider Demographics
NPI:1922793991
Name:INTEGRATIVE COUNSELING THERAPY
Entity Type:Organization
Organization Name:INTEGRATIVE COUNSELING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNAFOUX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:949-889-3867
Mailing Address - Street 1:15333 CULVER DR STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3051
Mailing Address - Country:US
Mailing Address - Phone:949-889-3867
Mailing Address - Fax:
Practice Address - Street 1:4001 BIRCH ST STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2265
Practice Address - Country:US
Practice Address - Phone:949-889-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty