Healthcare Provider Details

I. General information

NPI: 1063044394
Provider Name (Legal Business Name): PHOENIX CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N 2ND ST
IRONTON OH
45638-1235
US

IV. Provider business mailing address

PO BOX 614
IRONTON OH
45638-0614
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-7045
  • Fax:
Mailing address:
  • Phone: 740-442-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KASEY MCCALLISTER
Title or Position: COMPLIANCE AND RISK DIRECTOR
Credential:
Phone: 740-442-7045