Healthcare Provider Details

I. General information

NPI: 1740842277
Provider Name (Legal Business Name): INTEGRATED CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 31ST ST STE G
LAWRENCE KS
66047-3051
US

IV. Provider business mailing address

2500 W 31ST ST STE G
LAWRENCE KS
66047-3051
US

V. Phone/Fax

Practice location:
  • Phone: 913-961-4937
  • Fax:
Mailing address:
  • Phone: 913-961-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMEE HORTON
Title or Position: OWNER/THERAPIST
Credential: LSCSW, LMAC
Phone: 913-961-4937