Integrated Life Counseling Center, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3782 Issued in MN

Legal business name

INTEGRATED LIFE COUNSELING CENTER, PLLC

Practice address

8931 33Rd Street N
Lake Elmo, MN 55042-8900

Phone

(651) 242-9608

Fax

(651) 756-8138

NPI assigned

Nov 14, 2015

Last updated

Sep 2, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tracy Lee Kaye Swanson, LPCC

Title

Director of Communications

Phone

(651) 242-9608

Specialties & licenses 4

Addresses

Other identifiers 4

Locations

Practitioners 4

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.

• Tracy Lee Kaye, M.A.

  • Mental Health Counselor
  • Maplewood, MN
  • NPI 1154562205
  NPD
• Kathryn Naomi Hall, L.P.

  • Counseling Psychologist
  • Maplewood, MN
  • NPI 1114091709
  NPD (past)
• Debra Kae Lorence Topel, L.M.F.T.

  • Marriage & Family Therapist
  • Maplewood, MN
  • NPI 1629138417
  NPD (past)
• Carolyn Sue Twist, LMFT

  • Marriage & Family Therapist
  • Dodgeville, WI
  • NPI 1225262496
  NPD (past)

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

{
    "created_epoch": "1447459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472774400000",
    "number": "1649644634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8931 33RD STREET N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428900",
            "telephone_number": "651-242-9608",
            "fax_number": "651-756-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8931 33RD STREET N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428900",
            "telephone_number": "651-242-9608",
            "fax_number": "651-756-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED LIFE COUNSELING CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-14",
        "last_updated": "2016-09-02",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LEE KAYE",
        "authorized_official_title_or_position": "DIRECTOR OF COMMUNICATIONS",
        "authorized_official_telephone_number": "651-242-9608",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00241",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3782",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "920",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2005",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629138417",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225262496",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114091709",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154562205",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean M Huscroft, PT, DPT
• Rahma Idris
• Illuminnate Family Chiropractic, Inc.
• Infinite Health Collaborative, PA
• Integrated Counseling & Wellness, LLC
• J&J Home Care, Inc. (Acti-Kare Responsive In-Home Care)
• Roger A Jacobson, CRNA
• Kael Jensen, MA, BS, NBC-HWC, CMT
• Kelania Jimenez, MD
• Jimmy G. Anderson, D.C.

• Clinical Psychologist in Lake Elmo, MN
• Providers in Lake Elmo, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.