Provider Demographics
NPI:1043968936
Name:PHOENIX THERAPY, LLC
Entity Type:Organization
Organization Name:PHOENIX THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-209-0105
Mailing Address - Street 1:240 US ROUTE 1 UNIT B1
Mailing Address - Street 2:#1008
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1367
Mailing Address - Country:US
Mailing Address - Phone:207-386-9875
Mailing Address - Fax:
Practice Address - Street 1:100 CLEARWATER DR UNIT 157
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1366
Practice Address - Country:US
Practice Address - Phone:207-209-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)