Provider Demographics
NPI:1902582133
Name:PHENOMENAL U PLLC
Entity Type:Organization
Organization Name:PHENOMENAL U PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:ALEXIA
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPC-A
Authorized Official - Phone:469-830-2848
Mailing Address - Street 1:1071 LAKE CAROLYN PKWY APT 3089
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4868
Mailing Address - Country:US
Mailing Address - Phone:469-830-2848
Mailing Address - Fax:
Practice Address - Street 1:1071 LAKE CAROLYN PKWY APT 3089
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4868
Practice Address - Country:US
Practice Address - Phone:469-830-2848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty