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General NPI Number Information
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NPI Number | 1912611245
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Entity Type | Organization
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Legal Business Name | PHOENIX ASCENSION COUNSELING LLC
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 635 W HIGHWAY 50
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City | O FALLON
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State | IL
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Zip | 62269-1941
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Country | US
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Telephone | 618-575-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 PICKETTS CT
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City | O FALLON
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State | IL
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Zip | 62269-6665
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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 | OWNER
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Name | CANDYCE BELL
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Credential | LCPC
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Telephone | 847-340-1922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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