Provider Demographics
NPI:1962052258
Name:EUDAIMONIA COUNSELING AND RECOVERY SERVICES
Entity type:Organization
Organization Name:EUDAIMONIA COUNSELING AND RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC
Authorized Official - Phone:719-322-6108
Mailing Address - Street 1:436 E SAINT VRAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-6005
Mailing Address - Country:US
Mailing Address - Phone:719-322-6108
Mailing Address - Fax:
Practice Address - Street 1:5555 ERINDALE DR STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6965
Practice Address - Country:US
Practice Address - Phone:719-315-0685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty