Organization Active NPI

Integrated Health Clinical Counseling P.L.L.C.

  • Mental Health Counselor
  • Ponte Vedra, FL
National Provider Identifier
1053833566
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.
Practice address
90 Fort Wade Rd Ste 100
Ponte Vedra, FL 32081-5114
Phone
(734) 720-9782
Fax
(734) 571-6888
NPI assigned
Jul 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karl KunziNPI 1215284229
Title
Owner
Phone
(734) 720-9782

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

90 Fort Wade Rd Ste 100
Ponte Vedra, FL 32081-5114

Mailing address

90 Fort Wade Rd Ste 100
Ponte Vedra, FL 32081-5114
Phone (734) 787-2183

Other practice location 1

2955 Biddle Ave
Wyandotte, MI 48192-5231
Phone (734) 720-9782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240812000530 FL Part B Supplier - Clinic/Group Practice 3577925080 Receives reassigned benefits from 1 practitioner
Practice locations: Ponte Vedra, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1053833566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 FORT WADE RD STE 100",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815114",
            "telephone_number": "734-787-2183",
            "fax_number": "734-571-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 FORT WADE RD STE 100",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320815114",
            "telephone_number": "734-720-9782",
            "fax_number": "734-571-6888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2955 Biddle Ave",
            "address_purpose": "LOCATION",
            "city": "Wyandotte",
            "state": "MI",
            "postal_code": "481925231",
            "country_code": "US",
            "telephone_number": "734-720-9782",
            "fax_number": "734-571-6888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED HEALTH CLINICAL COUNSELING P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-17",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "KUNZI",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-720-9782"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.