MEDICARE: A PHOENIX RISING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	101YM0800X	Mental Health Counselor
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033736699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PHOENIX RISING, LLC

Provider Business Mailing Address
First Line	:	308 W FILLMORE ST STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6000
Country	:	US
Telephone Number	:	719-439-6785
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 W FILLMORE ST STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6000
Country	:	US
Telephone Number	:	719-439-6785
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. XANDER JOHN BURGESS
Credential	:	LPC, LMFT
Telephone Number	:	719-439-6785

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	04/16/2025

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