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General NPI Number Information
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NPI Number | 1427460302
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE THERAPEUTIC COUNSELING AND CONSULTANTS
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 5935 HIGHWAY 18 W STE C
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City | JACKSON
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State | MS
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Zip | 39209-9626
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Country | US
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Telephone | 601-750-9909
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Fax |
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Provider Business Mailing Address
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Address Line | 5935 HIGHWAY 18 W STE C
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City | JACKSON
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State | MS
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Zip | 39209-9626
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Country | US
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Telephone | 601-750-9909
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | MRS. CATRINA DURR
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Credential | LMSW
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Telephone | 601-750-9909
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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 |
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License Number State |
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