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General NPI Number Information
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NPI Number | 1861140006
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL HEALTH GROUP LLC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 3436 MAGAZINE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2480
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Country | US
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Telephone | 318-737-0449
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Fax |
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Provider Business Mailing Address
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Address Line | 3436 MAGAZINE ST # 8024
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2413
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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 | PSYCHOTHERAPIST
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Name | JONATHAN PORTER
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Credential | LPC
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Telephone | 318-737-0449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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