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General NPI Number Information
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NPI Number | 1942722079
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Entity Type | Organization
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Legal Business Name | PHOENIX PSYCHOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 423 3RD AVE SE STE 201
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City | ROCHESTER
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State | MN
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Zip | 55904-4897
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Country | US
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Telephone | 507-261-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 519 SOUTH AVE SE
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City | EYOTA
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State | MN
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Zip | 55934-2918
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Country | US
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Telephone | 507-261-2981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA BRIGGS
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Credential | MA, LPCC
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Telephone | 507-261-2981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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