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General NPI Number Information
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NPI Number | 1912509480
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Entity Type | Organization
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Legal Business Name | INTEGRITY BEHAVIORAL & COACHING SOLUTIONS, LLC
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 2561 MOODY BLVD STE 209
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4403
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Country | US
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Telephone | 407-782-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 102 SEA TRL
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City | PALM COAST
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State | FL
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Zip | 32164-5596
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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 | CLINICAL DIRECTOR
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Name | BARTOLOME E COLOM
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Credential | LMHC
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Telephone | 407-782-5525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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