MEDICARE: INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053833566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.

Provider Business Mailing Address
First Line	:	90 FORT WADE RD STE 100
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5114
Country	:	US
Telephone Number	:	734-787-2183
Fax Number	:	734-571-6888

Provider Business Practice Location Address
First Line	:	90 FORT WADE RD STE 100
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5114
Country	:	US
Telephone Number	:	734-720-9782
Fax Number	:	734-571-6888

Authorized Official
Title or Position	:	OWNER
Name	:	KARL KUNZI
Credential	:
Telephone Number	:	734-720-9782

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/15/2024

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