=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215896162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE PHOENIX MENTAL HEALTH COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2026
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1349 AYRAULT RD APT 101
-----------------------------------------------------
City | FAIRPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14450-8913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-479-0211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 173
-----------------------------------------------------
City | FAIRPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14450-0173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-479-0211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KANZA CHATMAN
-----------------------------------------------------
Credential | LMHC-D
-----------------------------------------------------
Telephone | 585-479-0211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------