Organization
INTEGRO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY ROUMELL (EXECUTIVE DIRECTOR)
(517) 789-1234
Entity
Organization
Contact information
Practice address
1200 N WEST AVE, STE 300, JACKSON, MI 49202-2179
(517) 789-1234
(517) 784-7040
Mailing address
1200 N WEST AVE, STE 300, JACKSON, MI 49202-2179
(517) 789-1234
(517) 784-7040
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P10C810520
BLUE CROSS BLUE SHIELD
MI
Enumeration date
02/08/2008
Last updated
02/08/2008
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