1154310225 NPI number — UNIVERSAL COUNSELING SERVICES, INC.

Table of content: (NPI 1154310225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154310225 NPI number — UNIVERSAL COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL COUNSELING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154310225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 SEVERN ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21230-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-752-5525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 SEVERN ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-752-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULDEN
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-752-5525

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KC29 . This is a "CAREFIRST/BLUE CROSS/BLUE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T514 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 215468000 . This is a "MAGELLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 212150600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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