Healthcare Provider Details

I. General information

NPI: 1942593538
Provider Name (Legal Business Name): WINGS OF HOPE COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 PHAY AVE
CANON CITY CO
81212-2334
US

IV. Provider business mailing address

PO BOX 521
CANON CITY CO
81215-0521
US

V. Phone/Fax

Practice location:
  • Phone: 877-582-7839
  • Fax: 877-562-7839
Mailing address:
  • Phone: 877-582-7839
  • Fax: 877-582-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7038
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4723
License Number StateCO

VIII. Authorized Official

Name: MS. TIMOTHY R PEARSON
Title or Position: DIRECTOR
Credential: LPC ; CAC III
Phone: 719-275-8714