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General NPI Number Information
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NPI Number | 1740767268
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COUNSELING GROUP LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 1101 LAKE ST STE 404
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City | OAK PARK
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State | IL
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Zip | 60301-1048
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Country | US
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Telephone | 708-608-3538
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Fax | 708-608-3540
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Provider Business Mailing Address
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Address Line | 1101 LAKE ST STE 404
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City | OAK PARK
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State | IL
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Zip | 60301-1048
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Country | US
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Telephone | 708-608-3538
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Fax | 708-608-3540
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | ASHLEY F PINTO
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Credential | MA, LCPC
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Telephone | 708-608-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180008293
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License Number State | IL
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