MEDICARE: PHOENIXHEALTHLLC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1821957374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIXHEALTHLLC

Provider Business Mailing Address
First Line	:	701 NW MCNELLY RD STE 9
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-9160
Country	:	US
Telephone Number	:	479-877-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 NW MCNELLY RD STE 9
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-9160
Country	:	US
Telephone Number	:	479-877-5950
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	RUSSELL PRAUSE
Credential	:	LPC-S
Telephone Number	:	479-877-5950

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “PHOENIXHEALTHLLC ” Practice Location

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