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General NPI Number Information
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NPI Number | 1912651068
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Entity Type | Organization
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Legal Business Name | RISING PHOENIX COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 245 S 84TH ST STE L101
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City | LINCOLN
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State | NE
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Zip | 68510-2601
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Country | US
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Telephone | 402-490-2378
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 N 95TH ST
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City | LINCOLN
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State | NE
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Zip | 68507-3226
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Country | US
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Telephone | 402-490-2378
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVIN FLATMO
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Credential | PLMHP
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Telephone | 402-490-2378
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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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