MEDICARE: PHOENIX MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598696957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	130 N CHERRY ST STE 203
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-3460
Country	:	US
Telephone Number	:	913-378-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N CHERRY ST STE 203
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-3460
Country	:	US
Telephone Number	:	913-378-4279
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	ELIZABETH BERUBE
Credential	:	PMHNP-BC
Telephone Number	:	913-449-0944

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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