MEDICARE: RISING SUN THERAPY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548910763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING SUN THERAPY

Provider Business Mailing Address
First Line	:	4652 E PIEDMONT RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5555
Country	:	US
Telephone Number	:	614-955-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	4652 E PIEDMONT RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5555
Country	:	US
Telephone Number	:	614-955-0182
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA KAVANAGH
Credential	:	LPC
Telephone Number	:	614-955-0182

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “RISING SUN THERAPY ” Practice Location

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