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General NPI Number Information
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NPI Number | 1881959062
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Entity Type | Organization
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Legal Business Name | INTEGRATED CARE RESOURCES, INC.
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 394 W MAIN ST SUITE A21
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3348
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Country | US
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Telephone | 615-824-7780
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Fax | 615-827-0008
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Provider Business Mailing Address
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Address Line | 394 W MAIN ST SUITE A21
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-3348
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Country | US
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Telephone | 615-824-7780
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Fax | 615-827-0008
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRACIE LYNN TODD
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Credential | MSN, PMHNP
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Telephone | 615-824-7780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 14488
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License Number State | TN
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