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General NPI Number Information
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NPI Number | 1093303349
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Entity Type | Organization
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Legal Business Name | RISING PHOENIX COUNSELING L.C.
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 1471 DEWAR DR STE 216
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5826
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Country | US
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Telephone | 307-382-0743
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Fax | 844-861-9507
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Provider Business Mailing Address
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Address Line | 1471 DEWAR DR STE 216
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-5826
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Country | US
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Telephone | 307-382-0743
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Fax | 844-861-9507
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | TIFFANI JEAN BEATTY
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Credential | LCSW
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Telephone | 307-382-0743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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