Healthcare Provider Details

I. General information

NPI: 1235583865
Provider Name (Legal Business Name): INTEGRATIVE COUNSELING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 198S
CINCINNATI OH
45255-3637
US

IV. Provider business mailing address

431 OHIO PIKE STE 198S
CINCINNATI OH
45255-3637
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-1705
  • Fax: 513-770-1705
Mailing address:
  • Phone: 513-770-1705
  • Fax: 513-770-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1100061 SUPV
License Number StateOH

VIII. Authorized Official

Name: MRS. CRYSTAL A HUBBELL
Title or Position: THERAPIST/SUPERVISER
Credential: L.P.C.C. SUPV
Phone: 513-770-1705