Healthcare Provider Details

I. General information

NPI: 1598696957
Provider Name (Legal Business Name): PHOENIX MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N CHERRY ST STE 203
OLATHE KS
66061-3460
US

IV. Provider business mailing address

130 N CHERRY ST STE 203
OLATHE KS
66061-3460
US

V. Phone/Fax

Practice location:
  • Phone: 913-378-4279
  • Fax:
Mailing address:
  • Phone: 913-378-4279
  • Fax:

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: ELIZABETH BERUBE
Title or Position: PMHNP
Credential: PMHNP-BC
Phone: 913-449-0944