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General NPI Number Information
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NPI Number | 1023101763
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING SERVICES, INCORPORATED
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 PARK PLACE CIRCLE SUITE 150
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City | MISHAWAKA
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State | IN
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Zip | 46545
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Country | US
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Telephone | 574-276-8143
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Fax | 574-273-2477
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Provider Business Mailing Address
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Address Line | P.O. BOX 1137
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City | SOUTH BEND
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State | IN
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Zip | 46624
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Country | US
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Telephone | 574-276-8143
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Fax | 574-273-2477
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PATRICIA A. KUBOSKE
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Credential | L.C.S.W.
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Telephone | 574-276-8143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34003645A
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License Number State | IN
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