Inner City Community Services, Inc.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

63484 Issued in TX

Legal business name

INNER CITY COMMUNITY SERVICES, INC.

Practice address

5811 Berkman Dr
Suite 132
Austin, TX 78723-2666

Phone

(512) 809-1695

Fax

(206) 337-7327

NPI assigned

May 13, 2010

Organization subpart

No

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

Authorized official

Name

Mitchell Edwards

Title

President

Phone

(512) 809-1695

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1295053304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5811 BERKMAN DR",
            "address_2": "SUITE 132",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787232666",
            "telephone_number": "512-809-1695",
            "fax_number": "206-337-7327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5811 BERKMAN DR",
            "address_2": "SUITE 132",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787232666",
            "telephone_number": "512-809-1695",
            "fax_number": "206-337-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER CITY COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-13",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-809-1695"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "63484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Austin, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.