Provider Demographics
NPI:1326690595
Name:PHOENIX COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:PHOENIX COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERWILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-463-4627
Mailing Address - Street 1:1820 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-6898
Mailing Address - Country:US
Mailing Address - Phone:501-463-4627
Mailing Address - Fax:501-463-4629
Practice Address - Street 1:1820 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6898
Practice Address - Country:US
Practice Address - Phone:501-463-4627
Practice Address - Fax:501-463-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty