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General NPI Number Information
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NPI Number | 1841199536
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Entity Type | Organization
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Legal Business Name | MISTY MOUNTAIN PHOENIX RISING, A CHILD AND FAMILY COUNSELING CORPORATION
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 23550 LYONS AVE STE 211
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City | NEWHALL
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State | CA
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Zip | 91321-5745
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Country | US
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Telephone | 818-602-3680
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Fax |
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Provider Business Mailing Address
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Address Line | 22314 CANONES CIR
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2244
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Country | US
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Telephone | 818-602-3680
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Fax | 661-309-4677
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | WENDY ROZELLE
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Credential | LMFT
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Telephone | 818-602-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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