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General NPI Number Information
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NPI Number | 1295053304
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Entity Type | Organization
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Legal Business Name | INNER CITY COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 5811 BERKMAN DR SUITE 132
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City | AUSTIN
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State | TX
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Zip | 78723-2666
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Country | US
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Telephone | 512-809-1695
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Fax | 206-337-7327
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Provider Business Mailing Address
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Address Line | 5811 BERKMAN DR SUITE 132
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City | AUSTIN
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State | TX
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Zip | 78723-2666
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Country | US
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Telephone | 512-809-1695
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Fax | 206-337-7327
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Authorized Official
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Title or Position | PRESIDENT
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Name | MITCHELL EDWARDS
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Credential |
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Telephone | 512-809-1695
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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 | 63484
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License Number State | TX
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