Provider Demographics
NPI:1851555999
Name:WINGS OF GRACE CHRISTIAN MINISTRIES, INC.
Entity Type:Organization
Organization Name:WINGS OF GRACE CHRISTIAN MINISTRIES, INC.
Other - Org Name:WINGS OF GRACE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF STRATEGY & DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-600-1088
Mailing Address - Street 1:4585 HILTON PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3569
Mailing Address - Country:US
Mailing Address - Phone:888-600-1088
Mailing Address - Fax:719-599-4693
Practice Address - Street 1:4585 HILTON PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3569
Practice Address - Country:US
Practice Address - Phone:888-600-1088
Practice Address - Fax:719-599-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10180101YM0800X
CO10195101YM0800X
CO7995101YM0800X
CO482101YP2500X
CO4722101YP2500X
CO4496101YP2500X
CO7641041C0700X
MI68020577781041C0700X
CO268106H00000X
CO659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty