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General NPI Number Information
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NPI Number | 1396268330
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Entity Type | Organization
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Legal Business Name | PHOENIX RISE THERAPEUTIC GROUP
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2525 FERRAND ST
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City | MONROE
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State | LA
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Zip | 71201-3210
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Country | US
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Telephone | 318-582-5880
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Fax | 318-582-5840
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Provider Business Mailing Address
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Address Line | 2525 FERRAND ST
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City | MONROE
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State | LA
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Zip | 71201-3210
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Country | US
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Telephone | 318-582-5880
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Fax | 318-582-5840
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | MRS. KEISHA L BELL-CELESTAND
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Credential | LPC
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Telephone | 318-582-5880
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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 | 5132
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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