Basic Information
| Provider Information | |||||||||
| NPI: | 1881064087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNATIONAL COUNSELING AND PSYCHOLOGICAL SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 W CHANDLER BLVD STE 15-212 | ||||||||
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| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807214880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 N DOBSON RD STE D-3 | ||||||||
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| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852249610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807214880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | OBANA | ||||||||
| AuthorizedOfficialFirstName: | MAKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4807214880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4097 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.