Organization
INTEGRATED LIFE COUNSELING CENTER, PLLC
Active
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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