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General NPI Number Information
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NPI Number | 1639406663
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Entity Type | Organization
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Legal Business Name | PREMIER COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 3920 N UNION BLVD SUITE 370
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-4900
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Country | US
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Telephone | 719-388-0194
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Fax | 719-522-1168
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Provider Business Mailing Address
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Address Line | PO BOX 63312
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City | COLORADO SPRINGS
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State | CO
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Zip | 80962-3312
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Country | US
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Telephone | 719-388-0194
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STACIE BRYANT
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Credential | LMFT
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Telephone | 719-388-0194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT893
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License Number State | CO
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