MEDICARE: INNOVATIVE COUNSELING SERVICES, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629772397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	38271 MOUND RD STE 300
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3403
Country	:	US
Telephone Number	:	586-909-5031
Fax Number	:	248-266-1688

Provider Business Practice Location Address
First Line	:	38271 MOUND RD STE 300
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3403
Country	:	US
Telephone Number	:	586-909-5031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC J BLACK
Credential	:	LPC
Telephone Number	:	248-877-6003

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	10/09/2025

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