Provider Demographics
NPI:1952730137
Name:INTEGRATIVE COUNSELING CENTER LLC
Entity type:Organization
Organization Name:INTEGRATIVE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRISKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMFT
Authorized Official - Phone:316-749-2007
Mailing Address - Street 1:4425 W ZOO BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1620
Mailing Address - Country:US
Mailing Address - Phone:316-374-9200
Mailing Address - Fax:316-749-2008
Practice Address - Street 1:4425 W ZOO BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1620
Practice Address - Country:US
Practice Address - Phone:316-374-9200
Practice Address - Fax:316-749-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS735251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health