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General NPI Number Information
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NPI Number | 1942593538
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Entity Type | Organization
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Legal Business Name | WINGS OF HOPE COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 1335 PHAY AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2334
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Country | US
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Telephone | 877-582-7839
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Fax | 877-562-7839
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Provider Business Mailing Address
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Address Line | PO BOX 521
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City | CANON CITY
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State | CO
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Zip | 81215-0521
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Country | US
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Telephone | 877-582-7839
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Fax | 877-582-7839
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. TIMOTHY R PEARSON
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Credential | LPC ; CAC III
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Telephone | 719-275-8714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4723
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7038
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License Number State | CO
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