Provider Demographics
NPI:1023101763
Name:PHOENIX COUNSELING SERVICES, INCORPORATED
Entity type:Organization
Organization Name:PHOENIX COUNSELING SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUBOSKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-276-8143
Mailing Address - Street 1:P.O. BOX 1137
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46624
Mailing Address - Country:US
Mailing Address - Phone:574-276-8143
Mailing Address - Fax:574-273-2477
Practice Address - Street 1:425 PARK PLACE CIRCLE
Practice Address - Street 2:SUITE 150
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-276-8143
Practice Address - Fax:574-273-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003645A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty