Provider Demographics
NPI:1538811435
Name:PHOENIX COUNSELING SERVICE, INC.
Entity type:Organization
Organization Name:PHOENIX COUNSELING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-956-5059
Mailing Address - Street 1:7281 SUNSHINE GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6800
Mailing Address - Country:US
Mailing Address - Phone:352-389-1816
Mailing Address - Fax:352-389-1119
Practice Address - Street 1:8909 REGENTS PARK DR STE 420
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3432
Practice Address - Country:US
Practice Address - Phone:352-389-1816
Practice Address - Fax:352-389-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management