Provider Demographics
NPI:1891075289
Name:THE OTHER SIDE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:THE OTHER SIDE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:REAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-327-1046
Mailing Address - Street 1:1051 N COLUMBUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1100
Mailing Address - Country:US
Mailing Address - Phone:520-327-1046
Mailing Address - Fax:
Practice Address - Street 1:1051 N COLUMBUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1100
Practice Address - Country:US
Practice Address - Phone:520-327-1046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MD112861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty