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General NPI Number Information
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NPI Number | 1043731359
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING BEHAVIORAL THERAPIES PLLC
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 209 CHRISTIE STREET
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City | LUFKIN
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State | TX
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Zip | 75904
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Country | US
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Telephone | 936-404-3679
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Fax |
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Provider Business Mailing Address
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Address Line | 209 CHRISTIE STREET
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City | LUFKIN
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State | TX
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Zip | 75904
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Country | US
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Telephone | 936-404-3679
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST AND COUNSELOR
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Name | KYLE HANES
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Credential | M.ED., LBA, BCBA,LPC
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Telephone | 936-404-3679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68436
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-23321
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License Number State | TX
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