Organization Name: | INNOVATIVE PSYCHOLOGY COUNSELING SERVICES, INC. |
NPI Number: | 1013378108 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD MALCZYNSKI (CHIEF FINANCIAL OFFICER) |
Mailing Address: | 4318 W Crystal Lake Rd Unit L Mchenry |
State: | IL US |
Postal Code: | 600504210 |
Phone Number: | 8475082016 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2016 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180008289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |