Organization Name: | INTEGRATIVE COUNSELING SERVICES |
NPI Number: | 1083826200 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD ELBERT RIDDLE (PRESIDENT) |
Mailing Address: | 472-100 Richmond Rd N Susanville |
State: | CA US |
Postal Code: | 96130 |
Phone Number: | 5302575462 |
Fax Number: | 5302578954 |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |