Provider Demographics
NPI:1952789778
Name:INTEGRATED COUNSELING & MEDIATION SERVICES
Entity type:Organization
Organization Name:INTEGRATED COUNSELING & MEDIATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-KEKENAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-558-1344
Mailing Address - Street 1:12360 66TH ST STE Y3
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3434
Mailing Address - Country:US
Mailing Address - Phone:727-558-1344
Mailing Address - Fax:
Practice Address - Street 1:12360 66TH ST STE Y3
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3434
Practice Address - Country:US
Practice Address - Phone:727-558-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty