Provider Demographics
NPI:1861215865
Name:PHOENIX COUNSELING
Entity type:Organization
Organization Name:PHOENIX COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC, LAC
Authorized Official - Phone:701-367-1079
Mailing Address - Street 1:725 CENTER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1972
Mailing Address - Country:US
Mailing Address - Phone:218-366-6162
Mailing Address - Fax:
Practice Address - Street 1:725 CENTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1972
Practice Address - Country:US
Practice Address - Phone:218-366-6162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty