MEDICARE: AMERICAN COUNSELING SERVICE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency	1741-01	CO

General Provider Information

NPI Number	:	1184040131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN COUNSELING SERVICE INC

Provider Business Mailing Address
First Line	:	3520 GALLEY RD STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4344
Country	:	US
Telephone Number	:	719-963-8740
Fax Number	:	719-570-4323

Provider Business Practice Location Address
First Line	:	3520 GALLEY RD STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4344
Country	:	US
Telephone Number	:	719-963-8740
Fax Number	:	719-570-4323

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	SALENA E WIEMAN
Credential	:
Telephone Number	:	719-232-7981

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	04/23/2014

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