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General NPI Number Information
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NPI Number | 1083661334
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Entity Type | Organization
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Legal Business Name | INNOVATIVE COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1137 N MAIN ST
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City | O FALLON
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State | MO
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Zip | 63366-1217
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Country | US
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Telephone | 314-484-6198
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Fax |
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Provider Business Mailing Address
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Address Line | 621 BULL VALLEY DR
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City | SAINT PETERS
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State | MO
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Zip | 63304-8544
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Country | US
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Telephone | 314-484-6198
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA MARIE EISENBEIS
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Credential | MSW LCSW
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Telephone | 314-484-6198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2005040010
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License Number State | MO
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