Provider Demographics
NPI:1679896088
Name:PHASE TWO COUNSELING SERVICE
Entity Type:Organization
Organization Name:PHASE TWO COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES-DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-473-1805
Mailing Address - Street 1:833 E PLATTE AVE
Mailing Address - Street 2:L-3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-5512
Mailing Address - Country:US
Mailing Address - Phone:719-473-1805
Mailing Address - Fax:719-302-5324
Practice Address - Street 1:833 E PLATTE AVE
Practice Address - Street 2:L-3
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-5512
Practice Address - Country:US
Practice Address - Phone:719-473-1805
Practice Address - Fax:719-302-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6148302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization