Healthcare Provider Details

I. General information

NPI: 1457829913
Provider Name (Legal Business Name): INTEGRATED THERAPY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303A MCKENZIE AVE
COUNCIL BLUFFS IA
51503-1014
US

IV. Provider business mailing address

303A MCKENZIE AVE
COUNCIL BLUFFS IA
51503-1014
US

V. Phone/Fax

Practice location:
  • Phone: 712-986-7800
  • Fax:
Mailing address:
  • Phone: 712-986-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN S MARCUM
Title or Position: OWNER/ADMIN
Credential: LMHC
Phone: 712-986-7800