Provider Demographics
NPI:1760575500
Name:KOLPIA COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:KOLPIA COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CADC III, MAC
Authorized Official - Phone:541-482-1718
Mailing Address - Street 1:611 SISKIYOU BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2151
Mailing Address - Country:US
Mailing Address - Phone:541-482-1718
Mailing Address - Fax:541-482-0964
Practice Address - Street 1:611 SISKIYOU BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2151
Practice Address - Country:US
Practice Address - Phone:541-482-1718
Practice Address - Fax:541-482-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR025136000OtherBLUE CROSS BLUE SHIELD
ORJ0314OtherPACIFIC SOURCE
OR6260118OtherUNITED HEALTHCARE
OR0001026863OtherMHN SERVICES
OR165327OtherOREGON HEALTH PLAN