Provider Demographics
NPI:1144079518
Name:PHOENIX RISING COUNSELING L.L.C
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLMSW
Authorized Official - Prefix:
Authorized Official - First Name:KAYMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-970-4661
Mailing Address - Street 1:2521 WOODLAKE RD SW APT 4
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2521 WOODLAKE RD SW APT 4
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4712
Practice Address - Country:US
Practice Address - Phone:616-970-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health