Provider Demographics
NPI:1255883880
Name:INTENTIONAL COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:INTENTIONAL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:480-428-2549
Mailing Address - Street 1:3231 S COUNTRY CLUB WAY
Mailing Address - Street 2:STE 111
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4053
Mailing Address - Country:US
Mailing Address - Phone:480-428-2549
Mailing Address - Fax:480-659-7230
Practice Address - Street 1:3231 S COUNTRY CLUB WAY
Practice Address - Street 2:STE 111
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4053
Practice Address - Country:US
Practice Address - Phone:480-428-2549
Practice Address - Fax:480-659-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13969101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty