Healthcare Provider Details

I. General information

NPI: 1275873499
Provider Name (Legal Business Name): INNOVATIVE COUNSELING & CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 EUCLID AVE
DES MOINES IA
50310-5702
US

IV. Provider business mailing address

1063 14TH PL STE A
DES MOINES IA
50314-1245
US

V. Phone/Fax

Practice location:
  • Phone: 515-235-5224
  • Fax: 866-672-0706
Mailing address:
  • Phone: 515-235-5224
  • Fax: 866-672-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: BYRON JARRETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-235-5224