Healthcare Provider Details

I. General information

NPI: 1558935882
Provider Name (Legal Business Name): INTEGRATED COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 W DIVISION ST
SAINT CLOUD MN
56301-3725
US

IV. Provider business mailing address

3360 W DIVISION ST
SAINT CLOUD MN
56301-3725
US

V. Phone/Fax

Practice location:
  • Phone: 612-868-1599
  • Fax:
Mailing address:
  • Phone: 612-868-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ALI SALAH HASSAN
Title or Position: OWNER
Credential:
Phone: 612-868-1599