Basic Information
| Provider Information | |||||||||
| NPI: | 1316323686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED CARE SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 N 31ST AVE | ||||||||
| Address2: | SUITE C218 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850519582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024412388 | ||||||||
| FaxNumber: | 6025952511 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 N 31ST AVE | ||||||||
| Address2: | SUITE C218 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850519582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024412388 | ||||||||
| FaxNumber: | 6025952511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2015 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | OKORIE | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6024412388 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCSW-10962 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | LISAC-15037 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103T00000X | 1076 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 104100000X | LCSW-10962 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW-10962 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | LPC-13418 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.