Provider Demographics
NPI:1285053280
Name:FULCRUM COUNSELING, INC.
Entity type:Organization
Organization Name:FULCRUM COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:719-232-0642
Mailing Address - Street 1:422 E VERMIJO AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3778
Mailing Address - Country:US
Mailing Address - Phone:719-232-0176
Mailing Address - Fax:719-219-6200
Practice Address - Street 1:422 E VERMIJO AVE STE 211
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3778
Practice Address - Country:US
Practice Address - Phone:719-232-0176
Practice Address - Fax:719-219-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT0001117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty