Healthcare Provider Details

I. General information

NPI: 1477470839
Provider Name (Legal Business Name): PHOENIX RISING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 TAYLOR CIR OFC B
MONTGOMERY AL
36117-3411
US

IV. Provider business mailing address

6708 TAYLOR CIR OFC B
MONTGOMERY AL
36117-3411
US

V. Phone/Fax

Practice location:
  • Phone: 334-769-3580
  • Fax: 334-216-6360
Mailing address:
  • Phone: 334-769-3580
  • Fax: 334-216-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANNE FAGIN
Title or Position: OWNER
Credential:
Phone: 334-769-3580