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General NPI Number Information
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NPI Number | 1477429439
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Entity Type | Organization
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Legal Business Name | PHOENIX COLLECTIVE INC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 7456 MISSION GORGE ROAD UNIT 165
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City | SAN DIEGO
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State | CA
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Zip | 92120-1301
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Country | US
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Telephone | 619-535-0773
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Fax | 619-535-7055
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Provider Business Mailing Address
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Address Line | 344 N CENTRAL AVE APT 9
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City | MEDFORD
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State | OR
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Zip | 97501-5952
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Country | US
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Telephone | 619-535-0773
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Fax | 619-535-7055
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. ROBIN MATHY
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Credential | MSW, MSC, LCSW
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Telephone | 651-535-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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