1396883955 NPI number — PHOENIX COUNSELING SERVICES, INC.

Table of content: MRS. WHITNEY MARIE WENGLIKOWSKI LMSW (NPI 1487202016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396883955 NPI number — PHOENIX COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX 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:
1396883955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORRIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37828-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-548-7474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
729 CHARLES SEIVERS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-548-7474
Provider Business Practice Location Address Fax Number:
865-494-9819
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
MIRIAM 'MIMS'
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, THERAPIST
Authorized Official Telephone Number:
865-548-7474

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  298 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5441087 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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