Healthcare Provider Details

I. General information

NPI: 1700374774
Provider Name (Legal Business Name): RISING PHOENIX WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 08/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21803 N SCOTTSDALE RD BUILDING A, #110
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

21803 N SCOTTSDALE RD BUILDING A, #110
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-427-2290
  • Fax: 480-383-6808
Mailing address:
  • Phone: 480-427-2290
  • Fax: 480-383-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN LEIGH STANFIELD
Title or Position: CEO
Credential: LCSW
Phone: 480-215-3089