MEDICARE: PHOENIX RISING COUNSELING AND PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.00000140	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336520352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RISING COUNSELING AND PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	5931 MIDDLEFIELD RD STE 100
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2865
Country	:	US
Telephone Number	:	720-988-5620
Fax Number	:	720-554-7983

Provider Business Practice Location Address
First Line	:	5931 MIDDLEFIELD RD STE 100
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-2865
Country	:	US
Telephone Number	:	720-988-5620
Fax Number	:	720-554-7983

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ELENA PATRICIA DAVIS
Credential	:	LCSW
Telephone Number	:	720-988-5620

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	11/06/2025

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