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General NPI Number Information
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NPI Number | 1235263427
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING, LTD
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 1500 WEST MAIN STREET SUITE 300
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City | SUN PRAIRIE
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State | WI
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Zip | 53590
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Country | US
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Telephone | 608-825-6711
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Fax | 608-834-6499
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Provider Business Mailing Address
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Address Line | 1500 WEST MAIN ST. SUITE 300
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City | SUN PRAIRIE
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State | WI
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Zip | 53590
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Country | US
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Telephone | 608-825-6711
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Fax | 608-834-6499
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DAVID A KUYKENDALL
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Credential | MSW
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Telephone | 608-825-6711
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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 | 621
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License Number State | WI
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