NPIMap

Organization Active NPI

Phaze Counseling Services Inc

  • Rehabilitation Clinic/Center
  • Nottingham, MD
National Provider Identifier
1427669159
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PHAZE COUNSELING SERVICES INC
Practice address
4425 Fitch Ave Ste 118
Nottingham, MD 21236-3927
Phone
(443) 622-8755
NPI assigned
Aug 14, 2020
Organization subpart
Yes
Parent organization
PHAZE COUNSELING SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shanntel Monique GladneyNPI 1821437559
Title
Owner
Phone
(443) 622-8755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4425 Fitch Ave Ste 118
Nottingham, MD 21236-3927

Mailing address

4425 Fitch Ave Ste 118
Nottingham, MD 21236-3927
Phone (443) 622-8755

National Provider Directory

National Provider Directory
Tax ID family
Phaze Counseling Serv Inc3 organizations share this tax ID, including this one
Part of
Phaze Counseling Serv Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4425 Fitch Ave
Ste 118
Nottingham, MD 21236
Phone (410) 870-2125

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1427669159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 FITCH AVE STE 118",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363927",
            "telephone_number": "443-622-8755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 FITCH AVE STE 118",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363927",
            "telephone_number": "443-622-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHAZE COUNSELING SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHAZE COUNSELING SERVICES INC",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "SHANNTEL",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-622-8755"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.