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General NPI Number Information
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NPI Number | 1164971354
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COUNSELING & WELLNESS, LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 328 S CENTRAL AVE STE 203
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City | MEDFORD
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State | OR
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Zip | 97501-7274
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Country | US
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Telephone | 541-890-2572
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Fax |
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Provider Business Mailing Address
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Address Line | 661 LYNN LN
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City | CENTRAL POINT
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State | OR
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Zip | 97502-3735
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Country | US
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Telephone | 541-890-2572
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/PROFESSIONAL COUNSELOR
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Name | ELENA C MEYER
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Credential | LPC
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Telephone | 541-890-2572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C3874
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License Number State | OR
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