Provider Demographics
NPI:1093303349
Name:RISING PHOENIX COUNSELING L.C.
Entity Type:Organization
Organization Name:RISING PHOENIX COUNSELING L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-382-0743
Mailing Address - Street 1:1471 DEWAR DR STE 216
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5826
Mailing Address - Country:US
Mailing Address - Phone:307-382-0743
Mailing Address - Fax:844-861-9507
Practice Address - Street 1:1471 DEWAR DR STE 216
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5826
Practice Address - Country:US
Practice Address - Phone:307-382-0743
Practice Address - Fax:844-861-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY144270800Medicaid