Organization
INTEGRATED LIFE COUNSELING CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY LEE KAYE SWANSON LPCC (DIRECTOR OF COMMUNICATIONS)
(651) 242-9608
Entity
Organization
Contact information
Practice address
8931 33RD STREET N, LAKE ELMO, MN 55042-8900
(651) 242-9608
(651) 756-8138
Mailing address
8931 33RD STREET N, LAKE ELMO, MN 55042-8900
(651) 242-9608
(651) 756-8138
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
CC00241
MN
103TC0700X
Clinical Psychologist
Primary
LP3782
MN
106H00000X
Marriage & Family Therapist
2005
MN
106H00000X
Marriage & Family Therapist
920
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114091709
—
MN
05
—
1154562205
—
MN
05
—
1225262496
—
MN
05
—
1629138417
—
MN
Enumeration date
11/14/2015
Last updated
09/02/2016
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