MEDICARE: PHAZE COUNSELING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174397939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAZE COUNSELING SERVICES INC

Provider Business Mailing Address
First Line	:	8007 CORPORATE DR STE A
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8007 CORPORATE DR STE A
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-4905
Country	:	US
Telephone Number	:	410-874-9595
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHANNTEL MONIQUE GLADNEY
Credential	:
Telephone Number	:	443-622-8755

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “PHAZE COUNSELING SERVICES INC ” Practice Location

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