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General NPI Number Information
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NPI Number | 1821957374
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Entity Type | Organization
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Legal Business Name | PHOENIXHEALTHLLC
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 701 NW MCNELLY RD STE 9
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City | BENTONVILLE
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State | AR
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Zip | 72712-9160
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Country | US
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Telephone | 479-877-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 701 NW MCNELLY RD STE 9
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City | BENTONVILLE
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State | AR
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Zip | 72712-9160
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Country | US
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Telephone | 479-877-5950
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RUSSELL PRAUSE
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Credential | LPC-S
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Telephone | 479-877-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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