Provider Demographics
NPI:1629842141
Name:PHAZE COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:PHAZE COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNTEL
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-622-8755
Mailing Address - Street 1:8007 CORPORATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4905
Mailing Address - Country:US
Mailing Address - Phone:410-874-9595
Mailing Address - Fax:
Practice Address - Street 1:8007 CORPORATE DR STE A
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4905
Practice Address - Country:US
Practice Address - Phone:410-874-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation