Provider Demographics
NPI:1699228528
Name:PHASE TWO COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:PHASE TWO COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-473-1805
Mailing Address - Street 1:2019 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5818
Mailing Address - Country:US
Mailing Address - Phone:719-473-1805
Mailing Address - Fax:719-302-5324
Practice Address - Street 1:2019 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5818
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:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6148103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty