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General NPI Number Information
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NPI Number | 1013378108
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PSYCHOLOGY COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 4318 W CRYSTAL LAKE RD UNIT L
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City | MCHENRY
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State | IL
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Zip | 60050-4210
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Country | US
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Telephone | 847-508-2016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541
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City | WONDER LAKE
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State | IL
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Zip | 60097-0541
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. DONALD MALCZYNSKI
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Credential |
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Telephone | 847-508-2016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180008289
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License Number State | IL
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