Healthcare Provider Details

I. General information

NPI: 1104781327
Provider Name (Legal Business Name): PHOENIX RISING MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MELODY DR STE 505
NORTHGLENN CO
80234-4173
US

IV. Provider business mailing address

10701 MELODY DR STE 505
NORTHGLENN CO
80234-4173
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-7876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN WEBER
Title or Position: OWNER
Credential:
Phone: 971-258-3565