Healthcare Provider Details

I. General information

NPI: 1033736699
Provider Name (Legal Business Name): A PHOENIX RISING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W FILLMORE ST STE 201
COLORADO SPRINGS CO
80907-6000
US

IV. Provider business mailing address

308 W FILLMORE ST STE 201
COLORADO SPRINGS CO
80907-6000
US

V. Phone/Fax

Practice location:
  • Phone: 719-439-6785
  • Fax:
Mailing address:
  • Phone: 719-439-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. XANDER JOHN BURGESS
Title or Position: OWNER
Credential: LPC, LMFT
Phone: 719-439-6785