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General NPI Number Information
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NPI Number | 1639236516
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Entity Type | Organization
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Legal Business Name | INTEGRATED CARE CONCEPTS & CONSULTATION, LLC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 615 HOPE RD BUILDING 1B, SECOND FLOOR
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-389-0697
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Fax | 732-389-0611
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Provider Business Mailing Address
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Address Line | 615 HOPE RD BUILDING 1B, SECOND FLOOR
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-389-0697
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Fax | 732-389-0611
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Authorized Official
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Title or Position | OWNER
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Name | JOHN LARRY THOMPSON
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Credential | L.C.S.W.
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Telephone | 732-389-0697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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