Healthcare Provider Details

I. General information

NPI: 1821973066
Provider Name (Legal Business Name): PHOENIX MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RED WOLF TRL
BLUE MOUNDS WI
53517-9717
US

IV. Provider business mailing address

2905 RED WOLF TRL
BLUE MOUNDS WI
53517-9717
US

V. Phone/Fax

Practice location:
  • Phone: 608-289-6436
  • Fax:
Mailing address:
  • Phone: 608-289-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RENA CROSS
Title or Position: OWNER/THERAPIST
Credential: MS, LPC
Phone: 608-289-6436