Healthcare Provider Details

I. General information

NPI: 1316323686
Provider Name (Legal Business Name): INTEGRATED CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE SUITE C218
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

10000 N 31ST AVE SUITE C218
PHOENIX AZ
85051-9582
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2388
  • Fax: 602-595-2511
Mailing address:
  • Phone: 602-441-2388
  • Fax: 602-595-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15037
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-10962
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13418
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1076
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-10962
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-10962
License Number StateAZ

VIII. Authorized Official

Name: VICTOR O OKORIE
Title or Position: CHIEF CLINICAL OFFICER
Credential: LPC
Phone: 602-441-2388