Provider Demographics
| NPI: | 1023195146 |
|---|---|
| Name: | THE PHOENIX OF SANTA BARBARA, INC |
| Entity Type: | Organization |
| Organization Name: | THE PHOENIX OF SANTA BARBARA, INC |
| Other - Org Name: | CRESCEND HEALTH |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | AVA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | POLAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 805-965-3434 |
| Mailing Address - Street 1: | 107 E MICHELTORENA ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SANTA BARBARA |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 93101-1905 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 805-965-3434 |
| Mailing Address - Fax: | 805-965-3797 |
| Practice Address - Street 1: | 107 E MICHELTORENA ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SANTA BARBARA |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 93101-1905 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 805-965-3434 |
| Practice Address - Fax: | 805-965-3797 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-11-01 |
| Last Update Date: | 2018-04-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251X00000X | Agencies | Supports Brokerage | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
