MEDICARE: AWAKENED PHOENIX HEALING 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801758586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWAKENED PHOENIX HEALING LLC

Provider Business Mailing Address
First Line	:	500 W WILSON BRIDGE RD STE 75
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2238
Country	:	US
Telephone Number	:	614-636-2583
Fax Number	:	614-358-2582

Provider Business Practice Location Address
First Line	:	500 W WILSON BRIDGE RD STE 75
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-2238
Country	:	US
Telephone Number	:	614-636-2583
Fax Number	:	614-358-2582

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH PHOENIX
Credential	:	CNP
Telephone Number	:	614-636-2583

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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