Healthcare Provider Details

I. General information

NPI: 1649254954
Provider Name (Legal Business Name): INTEGRATED COUNSELING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-4829
US

IV. Provider business mailing address

64 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-4829
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-9562
  • Fax: 508-830-6735
Mailing address:
  • Phone: 508-830-9562
  • Fax: 508-830-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4342
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105196
License Number StateMA

VIII. Authorized Official

Name: ELIZABETH M RYAN
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 508-830-9562