Healthcare Provider Details

I. General information

NPI: 1164952164
Provider Name (Legal Business Name): RISING PHOENIX COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E JACKSON ST
MEDFORD OR
97504-6773
US

IV. Provider business mailing address

810 E JACKSON ST
MEDFORD OR
97504-6773
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-7111
  • Fax: 541-507-9118
Mailing address:
  • Phone: 541-500-7111
  • Fax: 541-507-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH MAY EILERTSON
Title or Position: OWNER/COUNSELOR/CLINICAL DIRECTOR
Credential: LPC, NCC, CCTP
Phone: 541-500-7111