=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376110510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILINGUAL COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2021
-----------------------------------------------------
Last Update Date | 03/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4180 CENTER PARK DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80916-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-418-9705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12772 MT OXFORD PL
-----------------------------------------------------
City | PEYTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80831-8205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-446-8701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICIAN
-----------------------------------------------------
Name | GLORY MCDANIEL
-----------------------------------------------------
Credential | LPC, LAC
-----------------------------------------------------
Telephone | 720-446-8701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------