| Integrated Life Counseling Center, Llc | |
|
215 N Main St 205 West Bend WI 53095-3347 | |
| (262) 416-2922 | |
| Not Available |
| Full Name | Integrated Life Counseling Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 215 N Main St, West Bend, Wisconsin |
| Authorized Official Name and Position | Hadwat Sankari (SOCIAL WORKER, LCSW) |
| Authorized Official Contact | 2624162922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Life Counseling Center, Llc 265 Terrace Dr West Bend WI 53095-4748 Ph: (262) 416-2922 | Integrated Life Counseling Center, Llc 215 N Main St 205 West Bend WI 53095-3347 Ph: (262) 416-2922 |
| NPI Number | 1518328277 |
|---|---|
| Provider Enumeration Date | 03/09/2016 |
| Last Update Date | 03/09/2016 |
| Medicare PECOS PAC ID | 9133427834 |
|---|---|
| Medicare Enrollment ID | O20160413001568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518328277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 7824-123 (Wisconsin) | Primary |
| Provider Name | Hadwat A Sankari |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467611673 PECOS PAC ID: 5496907875 Enrollment ID: I20121211000302 |
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