Healthcare Provider Details

I. General information

NPI: 1215896162
Provider Name (Legal Business Name): RISE PHOENIX MENTAL HEALTH COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CANAL LANDING BLVD STE 8
ROCHESTER NY
14626-5108
US

IV. Provider business mailing address

PO BOX 173
FAIRPORT NY
14450-0173
US

V. Phone/Fax

Practice location:
  • Phone: 585-204-6152
  • Fax: 585-348-2092
Mailing address:
  • Phone: 585-204-6151
  • Fax: 585-348-2092

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: KANZA CHATMAN
Title or Position: OWNER
Credential: LMHC-D
Phone: 585-204-6151