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General NPI Number Information
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NPI Number | 1316429756
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Entity Type | Organization
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Legal Business Name | VIVUS COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/01/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 108 EAST CHEYENNE RD SUITE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906
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Country | US
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Telephone | 719-359-3431
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Fax |
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Provider Business Mailing Address
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Address Line | 108 E CHEYENNE RD STE 201
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-2535
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Country | US
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Telephone | 719-359-3431
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ERONILDE CHAVES BUCKLEY
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Credential | MA, LPC, LAC
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Telephone | 719-359-3431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0000874
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0014711
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License Number State | CO
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