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General NPI Number Information
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NPI Number | 1144079518
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING COUNSELING L.L.C
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 2521 WOODLAKE RD SW APT 4
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City | WYOMING
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State | MI
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Zip | 49519-4712
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Country | US
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Telephone | 616-970-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 WOODLAKE RD SW APT 4
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City | WYOMING
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State | MI
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Zip | 49519-4712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LLMSW
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Name | KAYMI HARGROVE
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Credential |
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Telephone | 616-970-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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