MEDICARE: INTEGRITY COUNSELING SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency	CSLG7160	AZ

General Provider Information

NPI Number	:	1366823577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	6605 N 19TH AVE STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1628
Country	:	US
Telephone Number	:	520-370-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	6605 N 19TH AVE STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1628
Country	:	US
Telephone Number	:	520-370-9032
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. TERESA L KOLODNY
Credential	:	PH.D.
Telephone Number	:	520-370-9032

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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