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General NPI Number Information
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NPI Number | 1861215865
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 725 CENTER AVE STE 3
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City | MOORHEAD
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State | MN
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Zip | 56560-1972
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Country | US
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Telephone | 218-366-6162
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Fax |
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Provider Business Mailing Address
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Address Line | 725 CENTER AVE STE 3
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City | MOORHEAD
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State | MN
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Zip | 56560-1972
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Country | US
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Telephone | 218-366-6162
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARSHA M WICHMANN
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Credential | MA, LPCC, LADC, LAC
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Telephone | 701-367-1079
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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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