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General NPI Number Information
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NPI Number | 1629789565
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Entity Type | Organization
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Legal Business Name | INTEGRATED COUNSELING HEALTH SERVICES INC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 1250 MOORE LAKE DR E STE 212
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City | FRIDLEY
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State | MN
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Zip | 55432-5136
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Country | US
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Telephone | 612-479-2085
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 MOORE LAKE DR E STE 212
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City | FRIDLEY
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State | MN
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Zip | 55432-5136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | AYANLE ABDIHOOSH
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Credential |
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Telephone | 612-479-2085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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