Provider Demographics
NPI:1811468770
Name:INNOVATIVE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:INNOVATIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-863-6822
Mailing Address - Street 1:PO BOX 30640
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3010
Mailing Address - Country:US
Mailing Address - Phone:509-863-6822
Mailing Address - Fax:509-228-3116
Practice Address - Street 1:707 W 7TH AVE STE 320A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2833
Practice Address - Country:US
Practice Address - Phone:509-863-6822
Practice Address - Fax:509-228-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty