MEDICARE: WARRIOR SUPPORT CENTER

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	101YP2500X	Professional Counselor	3842	CO

General Provider Information

NPI Number	:	1487880837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARRIOR SUPPORT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 49158
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80949-9158
Country	:	US
Telephone Number	:	719-640-5445
Fax Number	:	719-687-1894

Provider Business Practice Location Address
First Line	:	313 N TEJON ST
Second Line	:	SUITE 15
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1243
Country	:	US
Telephone Number	:	719-640-5445
Fax Number	:	719-687-1894

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN KENNETH DUNCAN
Credential	:	LPC, CACIII
Telephone Number	:	719-640-5445

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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