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General NPI Number Information
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NPI Number | 1366983082
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COUNSELING AND PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 7199 KALAMAZOO AVE SE SUITE 231
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City | CALEDONIA
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State | MI
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Zip | 49316-7341
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Country | US
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Telephone | 616-278-0933
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Fax | 616-278-0931
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Provider Business Mailing Address
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Address Line | 7199 KALAMAZOO AVE SE SUITE 231
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City | CALEDONIA
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State | MI
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Zip | 49316-7341
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Country | US
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Telephone | 616-278-0933
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Fax | 616-278-0931
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | NICOLE WARE SPENCER
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Credential | PSYD, MPH
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Telephone | 616-278-0933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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