MEDICARE: PHOENIX RISING MENTAL HEALTH SERVICES, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1881480812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RISING MENTAL HEALTH SERVICES, PLLC

Provider Business Mailing Address
First Line	:	49396 CHESHIRE LN
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1262
Country	:	US
Telephone Number	:	317-432-2553
Fax Number	:

Provider Business Practice Location Address
First Line	:	49396 CHESHIRE LN
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-1262
Country	:	US
Telephone Number	:	317-432-2553
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER/CO-CLINICAL DIRECTOR
Name	:	MEGAN SPEES
Credential	:	MA, LLP, CAADC
Telephone Number	:	317-432-2553

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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