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General NPI Number Information
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NPI Number | 1245850056
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 555
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1265
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Country | US
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Telephone | 636-324-3388
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Fax | 636-688-8047
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Provider Business Mailing Address
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Address Line | 1034 S BRENTWOOD BLVD STE 555
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1265
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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 | FOUNDER CEO
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Name | ZHANNA KEETON
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Credential |
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Telephone | 636-324-3388
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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