Provider Demographics
NPI:1366983082
Name:INTEGRATIVE COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:INTEGRATIVE COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MPH
Authorized Official - Phone:616-278-0933
Mailing Address - Street 1:7199 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7341
Mailing Address - Country:US
Mailing Address - Phone:616-278-0933
Mailing Address - Fax:616-278-0931
Practice Address - Street 1:7199 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE 231
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7341
Practice Address - Country:US
Practice Address - Phone:616-278-0933
Practice Address - Fax:616-278-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty