Healthcare Provider Details

I. General information

NPI: 1730004821
Provider Name (Legal Business Name): PHOENIX PSYCHOTHERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24830 COTTRELL RD
HARRISON TOWNSHIP MI
48045-3305
US

IV. Provider business mailing address

24830 COTTRELL RD
HARRISON TOWNSHIP MI
48045-3305
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-3730
  • Fax:
Mailing address:
  • Phone: 858-336-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ANNE KIRCHHOFF
Title or Position: OWNER/THERAPIST
Credential: LMSW
Phone: 858-336-3730