MEDICARE: PHOENIX RISING WELLNESS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1851053755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RISING WELLNESS, LLC

Provider Business Mailing Address
First Line	:	10425 W NORTH AVE STE 311
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-2400
Country	:	US
Telephone Number	:	414-436-9918
Fax Number	:

Provider Business Practice Location Address
First Line	:	10425 W NORTH AVE STE 311
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-2400
Country	:	US
Telephone Number	:	414-436-9918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN MORRIS
Credential	:
Telephone Number	:	414-436-9918

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	06/29/2023

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